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

英文中文

Use of non metallic implant for medial malleolar prophylactic fixation in total ankle arthroplasty, a noninferiority study 全踝关节置换术中非金属植入物用于内踝预防性固定，一项非劣效性研究

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

Pub Date : 2025-07-14 DOI: 10.1016/j.fastrc.2025.100542

Cameron Meyer , Jae Yoon Kim , Orlando Martinez , Lauren M. Christie , Gregory Berlet

Metal screw fixation has been standard in orthopedic procedures but carries drawbacks including migration, breakage, and need for removal. New bio-integrative options have shown promise in fracture repair; but the use with prophylactic fixation in total ankle arthroplasty (TAA) is unclear. The purpose of this study was to compare outcomes of biointegrative implants versus no fixation in prophylactic medial malleolar fixation with TAA.

A retrospective review via surgeon operative database was performed including patients with primary total ankle arthroplasty by a single fellowship trained orthopedic foot and ankle surgeon between December 2018 and February 2024. Search was verified by billing documentation with a minimum of 1 year follow up. Objective patient data including age, comorbidities, smoking and social history were all recorded. Postoperative data was reviewed to assess perioperative complications specific to the two cohorts.

The authors reviewed 150 cases of a single surgeon performing total ankle replacement. When comparing postoperative complications between use of non metallic fixation to no fixation, this was 1.64% (n=1) to 5.65% (n=5) respectively. Intraoperative complications occurred in 60% (n=3/5) of patients without fixation while none were seen in the non metallic prophylactic cohort.

Non metallic implant designs continue to improve with bio-integrative benefits compared to no fixation of the medial malleolus in TAA. We found that intraoperative and postoperative complications are less likely with prophylactic fixation of the medial malleolus with a biointegrative implant. Further prospective studies are warranted to evaluate the long term benefit.

Level Of Evidence: Level 3, Retrospective Cohort Study.

金属螺钉固定已成为骨科手术的标准，但其缺点包括移位、断裂和需要移除。新的生物整合选择在骨折修复中显示出希望；但预防性固定在全踝关节置换术（TAA）中的应用尚不清楚。本研究的目的是比较生物整合植入物与无固定物在TAA预防性内踝固定中的效果。通过外科手术数据库进行回顾性分析，包括2018年12月至2024年2月期间由一名培训过的骨科足和踝关节外科医生进行的原发性全踝关节置换术患者。通过至少1年跟踪的账单文档验证了搜索。客观记录患者资料，包括年龄、合并症、吸烟情况和社会病史。回顾术后资料以评估两组患者的围手术期并发症。作者回顾了150例单个外科医生进行全踝关节置换术的病例。当比较使用非金属固定与不使用固定的术后并发症时，分别为1.64% （n=1）和5.65% （n=5）。术中并发症发生率为60% (n=3/5)，而非金属预防组无并发症发生。与TAA中内踝不固定相比，非金属植入物设计不断改进，具有生物综合效益。我们发现，使用生物整合植入物预防性内固定内踝，术中和术后并发症的可能性较低。需要进一步的前瞻性研究来评估其长期效益。证据等级：3级，回顾性队列研究。

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引用次数: 0

First case of calcaneal Brodie's abscess caused by Fusobacterium nucleatum in an immunocompetent adult 免疫功能正常的成人中首例由核梭杆菌引起的跟骨布罗迪脓肿

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

Pub Date : 2025-07-08 DOI: 10.1016/j.fastrc.2025.100539

Jobin Jacob Job , Zain Al Abdeen Al Zuabi , Nisha De Souza , Alauldeen Al Hussein , Zhikai Li , Chandra Pasapula

Subacute calcaneal osteomyelitis is a challenging condition with a high relapse rate. This case report presents the first documented instance of subacute osteomyelitis of the calcaneus caused by Fusobacterium nucleatum, manifesting as post-traumatic heel pain in a 24-year-old male. The patient presented with heel pain following a fall, with no history of penetrating injury or immunosuppression. Imaging (Radiograph/CT/MRI) revealed a growing lytic lesion with surrounding bone marrow edema in the calcaneum. Surgical drainage and debridement were performed, and intraoperative cultures identified Fusobacterium nucleatum. The patient was treated with parenteral tazocin and oral metronidazole, followed by six weeks of oral doxycycline and metronidazole. Inflammatory markers normalized over three weeks, and the patient showed satisfactory recovery with follow-up radiographs and clinical reviews. This case highlights the importance of considering Fusobacterium nucleatum in subacute calcaneal osteomyelitis and demonstrates the effectiveness of combined surgical and antibiotic treatment.

亚急性跟骨骨髓炎是一种具有挑战性的疾病，复发率高。本病例报告提出了首例由核梭杆菌引起的跟骨亚急性骨髓炎，表现为创伤后足跟疼痛，患者为24岁男性。患者在跌倒后出现足跟疼痛，无穿透性损伤或免疫抑制史。影像学（x线/CT/MRI）显示跟骨周围有溶解性病变伴骨髓水肿。进行手术引流和清创，术中培养鉴定出核梭杆菌。患者给予他唑星外注射和甲硝唑口服，随后给予强力霉素和甲硝唑口服6周。炎症指标在三周内恢复正常，随访x线片和临床检查显示患者恢复良好。本病例强调了亚急性跟骨髓炎中考虑核梭杆菌的重要性，并证明了手术和抗生素联合治疗的有效性。

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引用次数: 0

Technique for all arthroscopic Brostrom repair using novel biocomposite scaffold ligament graft 全关节镜下新型生物复合支架韧带修复Brostrom技术

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

Pub Date : 2025-07-07 DOI: 10.1016/j.fastrc.2025.100540

Jay S. Badell

Ankle sprains affect a large portion of the general population and are one of the most common reasons for emergency room visits in the United States and globally. In recent years the advent of synthetic ligament grafts has provided an option for repair of the diseased/injured ligament using an anatomic augmentation. Several of these ligament grafts exist, however long-term data is limited. There has been no report in literature of an all-arthroscopic technique with use of biocomposite scaffold ligament graft in repair of the lateral collateral ankle ligaments. Technique and case examples are described using an all-arthroscopic technique for anatomic lateral ankle ligament repair using a novel ligament graft. Five patients with refractory chronic ankle instability received all arthroscopic ATFL repair using the biocomposite scaffold ligament graft. Pre and post operative American orthopedic foot and ankle society score, foot function index score, visual analog pain scale scores were collected. Mean pre-operative American orthopedic foot and ankle society score, foot function index score, visual analog pain scale were 38.2 ± 22.7, 55.28 ± 29.8, 6.8 ± 2.2 respectively. Mean post-operative American orthopedic foot and ankle society score, foot function index score, visual analog pain scale were 88.0 ± 11.4, 16.4 ± 14.0, 1.6 ± 1.5 resp. This technique offers anatomic restoration of the lateral ankle ligamentous complex through a minimally invasive approach that can lead to quicker recovery and return to activity.

Level of Clinical Evidence: 5, Technique

踝关节扭伤影响了很大一部分普通人群，是美国和全球急诊室就诊的最常见原因之一。近年来，人工合成韧带移植物的出现为病变/损伤韧带的解剖增强修复提供了一种选择。有几种这样的韧带移植存在，但长期数据有限。目前尚无文献报道全关节镜下应用生物复合支架韧带移植修复踝关节外侧副韧带。技术和案例描述使用全关节镜技术解剖外侧踝关节韧带修复使用新型韧带移植物。5例难治性慢性踝关节不稳患者接受全关节镜下生物复合支架韧带移植修复。收集术前、术后美国骨科足踝社会评分、足功能指数评分、视觉模拟疼痛量表评分。术前美国骨科足踝社会评分、足功能指数评分、视觉模拟疼痛评分平均分别为38.2±22.7、55.28±29.8、6.8±2.2。术后美国骨科足踝社会评分、足功能指数评分、视觉模拟疼痛量表的平均评分分别为88.0±11.4、16.4±14.0、1.6±1.5。该技术通过微创入路提供踝关节外侧韧带复合体的解剖修复，可以更快地恢复和恢复活动。临床证据等级：5，技术

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引用次数: 0

Acute simultaneous correction of 4th and 5th brachymetatarsia: A case report 第4、5号短跖畸形急性同时矫治1例

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

Pub Date : 2025-07-03 DOI: 10.1016/j.fastrc.2025.100538

Taimur Hasan DPM, Kasandra Trott DPM, Meghan Susek DPM

Brachymetatarsia results from the premature closure of growth plates, leading to the development of an abnormally short metatarsal. This is typically congenital. The incidence is estimated to be between 0.02 % to 0.05 %. When evaluating cases involving more than one metatarsal, the combination of the first and fourth metatarsals is more common. The presentation of fourth and fifth brachymetatarsia is extremely rare. This case report serves as the first to discuss the acute correction of the fourth and fifth brachymetatarsia simultaneously.

A 15-year-old male patient presented with bilateral pain in the fourth sub-metatarsal region, accompanied by shortening and dorsal lateral aspect involvement of bilateral fourth digits. Sport activities worsened his symptoms, especially to the right fifth digit. Clinical, biomechanical, and radiographic evaluations were conducted. A plantar crease was observed bilaterally at the fourth sub-metatarsal region, along with varus deformity of the fifth digit and an elevated fourth digit.

Radiographically, a notable shortening of the fourth and fifth rays was observed in the metatarsal parabola, measuring 16.5 mm and 18.5 mm, respectively. The joint space appeared congruent, and a moderate plantar bowing of the fifth metatarsal was evident on lateral view. The patient underwent acute correction of the fourth and fifth metatarsals. Additionally, the patient underwent tendon lengthening and capsulotomies utilizing two separate incisions.

The patient experienced a successful recovery without complications, achieving complete relief of symptoms within a year. Two commonly utilized correction techniques include gradual lengthening with an external fixator and single-stage lengthening using a graft. In this case, the patient underwent single-stage lengthening, and post-operative serial radiographs demonstrated the full incorporation of the grafts.

Level of clinical evidence: IV

跖骨短畸形是由于生长板过早闭合，导致异常短的跖骨发育。这通常是先天性的。发病率估计在0.02%到0.05%之间。当评估涉及多个跖骨的病例时，第一和第四跖骨的合并更为常见。第四和第五次短跖畸形的出现是非常罕见的。本病例报告是第一个同时讨论第四和第五近跖畸形的急性矫治的病例。一名15岁男性患者表现为双侧第四跖下区疼痛，并伴有双侧第四指缩短和背外侧受累。体育活动加重了他的症状，尤其是右手第五指。进行了临床、生物力学和放射学评估。在双侧第4跖下区观察到足底皱褶，同时伴有第5指内翻畸形和第4指升高。x线片显示跖骨抛物线处第4线和第5线明显缩短，分别为16.5 mm和18.5 mm。关节间隙一致，侧面观察第五跖骨有中度足底弯曲。患者接受了第四和第五跖骨的急性矫正。此外，患者接受了肌腱延长术和两个独立切口的囊膜切开术。患者成功康复，无并发症，一年内症状完全缓解。两种常用的矫正技术包括使用外固定架逐渐延长和使用移植物单阶段延长。在本例中，患者接受了单期延长，术后系列x线片显示移植物完全融合。临床证据等级：IV

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引用次数: 0

Transverse tibial bone transport for treatment of calcaneal osteomyelitis: a case report 胫骨横骨转运治疗跟骨骨髓炎1例

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

Pub Date : 2025-07-02 DOI: 10.1016/j.fastrc.2025.100537

Ryan Stone DPM, FACFAS , Mikhail Samchukov MD , Byron Hutchison DPM, FACFAS

Soft tissue defects of the posterior heel region with underlying osteomyelitis are challenging conditions to manage, particularly in the setting of concomitant peripheral arterial disease and diabetes mellitus. Such wounds are associated with high rates of amputation, loss of independence and high mortality. Transverse bone transport (TBT) is an evolving technique involving gradual distraction of the tibial cortex to promote angiogenesis of the lower extremity, improving extremity perfusion and overall wound healing potential. Recent applications of this technique demonstrate favorable healing in diabetic foot wounds with improved limb salvage rates. Herein, we describe a unique case where TBT was employed in conjunction with external fixation to successfully achieve wound healing and limb preservation in the setting of a posterior heel wound with calcaneal osteomyelitis.

与潜在的骨髓炎的后跟区软组织缺损是具有挑战性的条件来管理，特别是在设置伴随的外周动脉疾病和糖尿病。这种伤口与截肢率高、丧失独立性和死亡率高有关。横骨运输（TBT）是一项不断发展的技术，涉及胫骨皮质的逐渐分散，以促进下肢血管生成，改善四肢灌注和整体伤口愈合潜力。该技术最近的应用表明，糖尿病足部伤口愈合良好，肢体保留率提高。在此，我们描述了一个独特的情况下，TBT结合外固定成功地实现伤口愈合和肢体保存后脚跟伤口与跟骨髓炎的设置。

引用次数: 0

Crossing screw fixation in first proximal phalanx fracture nonunion: A case report 交叉螺钉内固定治疗第一近端指骨骨折不愈合1例

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

Pub Date : 2025-07-01 DOI: 10.1016/j.fastrc.2025.100536

Alec R. Wroblewski DPM, Brennan K. Reardon DPM, AACFAS, Nicholas S. Powers DPM, FACFAS

Pedal phalangeal fractures are common, however, literature is lacking concerning reported treatment options for a hallux proximal phalanx nonunion. This case of a first proximal phalanx nonunion initially presented to the clinic following a traumatic injury and emergency room visit with radiographic analysis revealing a closed, mildly displaced first proximal phalanx fracture. After initial conservative treatment failed, the painful nonunion was treated operatively with open reduction and internal fixation. This report highlights the use of crossing screws as a method of surgical fixation with adjunctive use of bone allograft and bone stimulator, with immediate protected weightbearing included as part of the post-operative protocol. At 3 months following surgery, radiographic union was noted and the patient reported complete relief of pain. This supports utilizing the reported fixation method and weightbearing protocol, hopefully adding to the armamentarium available to practitioners when treating similar fractures and nonunions.

趾骨骨折是常见的，然而，缺乏文献报道的治疗方案的近端趾骨不连。本例首次近端指骨不连是在创伤性损伤和急诊室就诊后首次向诊所提出的，放射学分析显示闭合，轻度移位的第一近端指骨骨折。在最初的保守治疗失败后，疼痛的骨不连采用切开复位和内固定手术治疗。本报告强调使用交叉螺钉作为手术固定方法，辅助使用同种异体骨移植物和骨刺激器，并将立即保护负重作为术后方案的一部分。术后3个月，x线片显示愈合，患者报告疼痛完全缓解。这支持使用报道的固定方法和负重方案，希望增加从业人员在治疗类似骨折和不愈合时可用的装备。

引用次数: 0

The hook test for rupture of tibialis anterior tendon 胫骨前腱断裂的钩试验

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

Pub Date : 2025-06-25 DOI: 10.1016/j.fastrc.2025.100533

Om Lahoti

Background

Chronic rupture of the tibialis anterior tendon is uncommon, and delays in diagnosis are common. The reasons are multifactorial, and incomplete physical examination is one of them.

Methods

The author describes a Tibialis Anterior Tendon (TAT) hook test to aid in diagnosis. The test is based on the normal anatomy of the TAT at the ankle, and a positive test confirms a normal intact tendon. A negative test confirms loss of continuity. This is a simple test that can be performed quickly and easily. This is easy to teach.

Results

The author has been using the test since 2021 and has diagnosed four cases of TAT chronic tear by the end of 2024.

Conclusions

The tibialis anterior hook test helps diagnosis of chronic ruptures. This test has not been previously described in the literature. The technique and experience of the author are presented in this paper.

Levels of Evidence

Level IV – Case series

背景：慢性胫骨前腱断裂并不常见，诊断延误也很常见。原因是多方面的，体检不全是其中之一。方法采用胫骨前腱（TAT）钩形检查辅助诊断。该测试是基于脚踝处TAT的正常解剖结构，阳性测试确认正常完整的肌腱。阴性测试证实了连续性的丧失。这是一个简单的测试，可以快速和容易地执行。这很容易教。结果作者从2021年开始使用该测试，到2024年底诊断出4例TAT慢性撕裂。结论胫骨前钩试验有助于慢性骨折的诊断。这种测试在以前的文献中没有描述过。本文介绍了作者的技术和经验。证据等级IV级-案例系列

引用次数: 0

Clinical guidelines for the application of tibial cortex transverse transport for diabetic foot ulcers 胫骨皮质横向转运治疗糖尿病足溃疡的临床指南

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

Pub Date : 2025-06-20 DOI: 10.1016/j.fastrc.2025.100535

Gan Golshteyn DPM, FACFAS , Emmy Oji DPM, FACFAS , Mikhail Samchukov MD, Co-Director

引用次数: 0

Unique finding of intravascular papillary endothelial hyperplasia in the foot: A case report 脚部血管内乳头状内皮增生的独特发现：1例报告

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

Pub Date : 2025-06-18 DOI: 10.1016/j.fastrc.2025.100530

Callie Morlock DPM, AACFAS, Amanda Khoury DPM, AACFAS, Saloni Buch DPM, BS, Anna Hronek DPM, FACFAS, DABM, CWSP

Intravascular papillary endothelial hyperplasia (IPEH), also known as a Masson’s tumor, is a benign soft tissue mass secondary to reactive endothelial cells induced by inflammation and thrombosis. The diagnosis of IPEH cannot be achieved by clinical evaluation or imaging modalities alone as it mimics benign and malignant tumors. In order to get a definitive diagnosis and rule out other pathologies, surgical resection and histopathology are necessary. Our case report highlights a patient who developed a lesion after increasing activity initially diagnosed as a ganglion cyst. After ultrasound and MRI findings, surgical resection was recommended to rule out malignancy. Histopathology concluded the diagnosis of IPEH demonstrating the importance of surgical excision for a definitive diagnosis along with the mixed clinical and imaging presentation faced for this type of pathology.

血管内乳头状内皮增生（IPEH），也称为马松瘤，是一种良性软组织肿块，继发于炎症和血栓诱导的反应性内皮细胞。IPEH的诊断不能仅通过临床评估或影像学方式来实现，因为它模拟良性和恶性肿瘤。为了得到明确的诊断和排除其他病理，手术切除和组织病理学是必要的。我们的病例报告突出了一个病人，他在活动增加后出现病变，最初诊断为神经节囊肿。超声和MRI检查后，建议手术切除排除恶性肿瘤。组织病理学总结了IPEH的诊断，表明手术切除对于明确诊断的重要性，以及这种类型病理所面临的混合临床和影像学表现。

引用次数: 0

The role of intrinsic muscle flaps in the treatment of calcaneal osteomyelitis associated with heel ulceration in high-risk patients: proximally based abductor hallucis and abductor digiti minimi muscle flaps: Case report and a systematic review 内在肌瓣在治疗高危患者与跟跟溃疡相关的跟骨髓炎中的作用：近端外展幻肌和外展小指肌瓣：病例报告和系统回顾

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

Pub Date : 2025-06-18 DOI: 10.1016/j.fastrc.2025.100534

Efthymios Gkotsoulias DPM, FACFAS , David Kuten MD, FACC

The purpose of this study is to demonstrate the use of the abductor hallucis and abductor digiti minimi muscle flaps in high-risk patients with diabetes and peripheral vascular disease for limb salvage involving extensive nonhealing ulcerations of the heel with concomitant osteomyelitis. The second objective is to assess the outcomes and safety of these intrinsic muscles in the surgical reconstruction of foot and ankle wounds. The two patients in this study exemplify the use of intrinsic muscle flaps as a last resort for complex foot pathology. A systematic literature review was conducted using several databases and search engines. A total of twenty-six studies met the inclusion criteria and were used for data extraction. One hundred fifty-two patients, with a total of one hundred fifty-three limbs treated, underwent either abductor hallucis or abductor digiti minimi intrinsic muscle flap for coverage of various foot and ankle pathology. Successful wound healing occurred in all patients, attesting to procedural efficacy and reliability. A major complication occurred in one patient (0.6 %), experiencing complete loss of the flap that was successfully managed with a local fasciocutaneous flap. Despite existing evidence, larger comparative studies are needed to investigate the efficacy of abductor hallucis and abductor digiti minimi muscle flaps in foot and ankle reconstruction.

本研究的目的是证明外展幻肌和外展小指肌瓣在糖尿病和周围血管疾病的高危患者中用于肢体保留，包括伴随骨髓炎的广泛未愈合的足跟溃疡。第二个目的是评估这些内在肌肉在足部和踝关节创伤手术重建中的效果和安全性。本研究中的两名患者例证了内在肌瓣作为复杂足部病理的最后手段。使用几个数据库和搜索引擎进行了系统的文献综述。共有26项研究符合纳入标准，并用于数据提取。152例患者，共153个肢体接受了外展肌幻觉或外展小指内肌皮瓣，以覆盖足部和踝关节的各种病理。所有患者均成功创面愈合，证明了手术的有效性和可靠性。一个主要的并发症发生在一个患者（0.6%），经历皮瓣完全丢失，成功地处理了局部筋膜皮瓣。尽管已有证据，但需要更大的比较研究来调查外展幻肌和外展小指肌皮瓣在足和踝关节重建中的疗效。

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引用次数: 0

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

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