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

Limb salvage procedures can be complicated by large segmental defects. Aggressive tibio-talar debridement or possible talectomy, hardware removal, and revisional surgery often leave a large void. An ideal graft that is mechanically strong, readily available, disease free, capable of maintaining length, and possesses all three biologic properties (osteoinductive, osteoconductive and osteogenic) is difficult to find. 3D printed implants and allografts, such as femoral head, are viable options but may present with pitfalls such as increased cost and risk of nonunion. This case report outlines a novel limb salvage surgical technique for tibiocalcaneal arthrodesis with an ipsilateral fibular strut autograft. The harvested fibula is divided into struts, which are then assembled into a circular configuration and used to fill a large defect. This technique offers an accessible and affordable solution of providing both substantial bone graft to assist in tibiocalcaneal arthrodesis, while also maintaining length.

Purpose

Pes cavus can be a debilitating and painful condition requiring surgical intervention. There are many contributing factors to take into account when addressing the deformity. This study documents 21 cases of cavus foot reconstruction using the Cole osteotomy as the primary procedure for feet with an apex of deformity in the midfoot, demonstrating its powerful corrective capabilities.

Case study

16 Patients (21 Feet) (13 female, 3 male) (Ages 16–55, average age 36.8 years) underwent Cole osteotomy for midfoot driven pes cavus. Secondary procedures include: Hammertoe Arthrodesis (7/21), 1st Metatarsal DFWO (6/21), Plantar Fasciotomy (5/21), Tarsal Tunnel Release (3/21), Posterior Calcaneal Spur Resection (3/21), Ankle Ligament Repair (1/21). All patients had preand post-operative measurements of calcaneal inclination and Meary's angle.

Results

Mean pre-op calcaneal inclination angle 17°, mean post-op calcaneal inclination angle 7.75°, for an average of 9.25° of correction. Mean pre-op Meary's angle 23.25°, mean post-op Meary's angle 5.5°, for an average of 17.75° of correction.

Analysis and discussion

The Cole midfoot osteotomy is an underutilized procedure, and when done correctly can vastly improve deformity and function. All patients in the series had significant pain relief, and all patients with bilateral deformities returned for the contralateral foot. The procedure demonstrates substantial sagittal plane correction that is difficult to obtain by other means. The full write up includes critical detailed steps articulating vital insights to the success of the procedure.

Charcot neuroarthropathy is a destructive, chronic disease of the bone structure and joints, and is identified in patients experiencing peripheral neuropathy, frequently associated with diabetes. The foot and ankle are most impacted by Charcot neuroarthropathy; whereas the goal of management is to stabilize the joint to avoid pedal collapse, infection, and foot amputation. Novel surgical approaches and hardware have shown promise in achieving these goals, allowing patients to return to ambulation, while avoiding late-stage complications. This multicenter, retrospective, consecutive case series reviewed individuals with midfoot Charcot neuroarthropathy who underwent surgical reconstruction using a novel locking intramedullary nail (LIN) in the medial column with at least 36 months of follow-up. Patients were treated between 2019 and 2021.

This report presents data and outcomes on 30 patients with Charcot disease treated with a LIN to achieve stability and fusion along the medial column of the reconstruction, with 36-60 months of follow-up data. Of these patients, 93.3% (n = 28) demonstrated complete (multiple joint) fusion along the medial column while there were zero nonunions. Overall, the mean time to fusion was 14.1 weeks (range 10-18 weeks) and 18.1 weeks mean time to functional braced-weightbearing (range 12-28 weeks). Overall, this retrospective review investigated the long-term use of a novel LIN in Charcot neuroarthropathy patients. The success of this LIN was demonstrated by the rate of fusion and time to functional braced-weightbearing, and safety was demonstrated by the low incidence of adverse events. Overall, these results indicate that use of a LIN within the medial column to be successful in the surgical reconstruction of an unstable midfoot Charcot deformity.

Lower extremity wounds complicated by chronic limb threatening ischemia (CLTI), especially in the setting of diabetes mellitus, present significant challenges, often leading to delayed healing and increased risk of amputation with limited treatment modalities. The tibial transverse transport corticotomy technique is a novel approach and a promising intervention for severe diabetic foot ulcers (DFU). Three cases illustrate successful outcomes with the described procedure in which healing was challenged through conventional treatment methods. The tibial transverse transport corticotomy offers hope as an effective treatment modality for cases of severe diabetic foot ulcer, complicated by CLTI, to improve wound healing and limb salvage in the lower extremity.

Isolated acute traumatic subtalar dislocations are fairly rare. They correspond to the talar luxation, including the talonavicular and subtalar joints. The aim of this study was to evaluate the functional and radiological outcomes of conservative treatment after pure subtalar dislocation. The current retrospective study included 7 patients who had an isolated subtalar dislocation over a 5-year period. Of the 7 cases, 6 (85.7 %) had medial dislocations and 1 (14.28 %) had lateral dislocations. All patients underwent immediate closure reduction under anesthesia, followed by immobilization. No open reduction was needed. The mean follow-up was 38.2 months (range 23–53 months). The American Orthopedic Foot and Ankle Society ankle hindfoot mean score was 83 out of 100 points (range 71–91 points). Subtalar mobility was decreased in 3 patients (42.8 %). Subtalar osteoarthritis was seen in 1 case (14.28 %). There were no cases of avascular necrosis of the talus. Published data show that the prognosis for isolated acute traumatic subtalar dislocation is favorable. Medial dislocations are more common than lateral dislocations. Emergent closure reduction allows the removal of soft tissue injuries. The risk of posttraumatic subtalar osteoarthritis is significant, even in the absence of an initial subtalar lesion. Computed tomography after reduction allows the diagnosis of osteochondral lesions.

Subungual exostosis (SE) is a relatively common benign bone tumor occurring primarily in the distal phalanx of the toes, particularly the hallux. Nail deformities, such as onychocryptosis / paronychia, can present concurrently, leading to complex clinical scenarios. Although SE and onychocryptosis are separate conditions, their clinical presentations can sometimes overlap, mainly when SE occurs under the nail bed, leading to nail deformation and subsequent ingrowth. When an ingrown toenail accompanies SE, the situation can become more complex due to increased pain and risk of infection. Diagnosis in these cases requires careful clinical examination and imaging studies. Any surgical intervention for the SE should consider concurrent pathological nail growth and nail bed abnormalities. The ultimate treatment goal is restoring normal anatomy, including salvage of the nail plate.

Given these conditions' potential overlap and shared symptomatology, clinical vigilance is essential for appropriate diagnosis and treatment.

This paper reviews the interplay between these conditions, their combined impact on patient morbidity, and effective surgical management strategies.

Diabetic patients often experience lower extremity wounds resulting from foot deformity, poor circulation and neuropathy. Conditions such as gangrene or osteomyelitis often require surgical intervention resulting in large tissue defects. Use of a muscle flap may be considered to fill in the wound defect, cover exposed bones, and bring in well vascularized tissue to the area. Synthetic electrospun fiber matrix (SEFM) offers a unique construct to augment these flap procedures and allows for quicker wound healing. In the present two-patient case report, patients underwent SEFM-augmented abductor digiti minimi muscle flaps to encourage healing of large surgical defects on the lateral foot. Both patients presented with gangrenous and infected wounds requiring surgical resection and debridement of fifth metatarsal to address underlying osteomyelitis and necrotic bone. Subsequently, proximally or distally based abductor digiti minimi muscle flap was performed and the SEFM was then applied over the muscle flap. Both wounds achieved closure at around 14 weeks without complication. Use of the SEFM in conjunction with perforator-based muscle flaps represents a novel approach in treating poorly vascularized surgical wounds in a challenging patient population.

This cadaveric study assessed common areas that were missed during talonavicular (TN) joint preparation. The purpose was to demonstrate to foot and ankle surgeons that an accessory incision can help prepare the lateral aspect of the joint to optimize the chances of a successful arthrodesis. We not only assessed the quadrants that were least likely prepped, but also the difference in surface area prepped between one and two incision approaches. Twenty cadavers in total were prepared by two fellowship-trained foot and ankle surgeons. The percentage of the unprepared cartilage in the talonavicular joints were calculated. It was found that both the dorsolateral and plantar lateral quadrants were more likely to have unprepared surfaces, with plantar lateral being the least prepped. The additional incision led to a decrease in the percentage of total unprepared surface. The results of the present study suggest that there is an advantage to prepping the talonavicular joint with both a medial and lateral incision to ensure all cartilage is denuded so a successful arthrodesis can be obtained.