Foot & ankle international最新文献

Background: The peroneus longus (PL) tendon is increasingly used as an autograft for ligament and tendon reconstructions, particularly in populations where hamstring graft dimensions may be insufficient. However, donor-site ankle function and patient-reported outcomes measures (PROMs) after PL harvest remain underreported. This study aimed to evaluate changes in PROMs and range of motion (ROM) at the donor-site ankle 1 year after PL autograft harvest and the proportion exceeding minimal clinically important difference (MCID) thresholds.

Methods: Patients who underwent PL autograft harvest from January 2021 through April 2023 were retrospectively enrolled. PROMs-including the Single Assessment Numeric Evaluation (SANE), American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Cumberland Ankle Instability Tool (CAIT) score-were assessed preoperatively and at 1-year follow-up on the operated ankle. Ankle ROM was also measured. Donor-site morbidity was evaluated using MCID thresholds.

Results: Thirty-five patients (mean age: 43 ± 28 years) completed follow-up at a mean of 22.5 ± 10 months. Although ankle ROM was preserved with no statistically significant changes (P > .05), PROMs declined significantly compared with preoperative values (P < .05), with postoperative scores of SANE (92.3 ± 27.3), AOFAS (96.7 ± 10.7), FAOS (97.0 ± 23), and CAIT (27.4 ± 19.4). MCID thresholds were exceeded in 51.4% (SANE), 31.4% (AOFAS), 34.2% (FAOS), and 5.7% (CAIT) of patients. Two patients experienced transient sural nerve hypoesthesia, which resolved without long-term deficit.

Conclusion: PL tendon harvest was associated with preserved ankle ROM at 1 year but demonstrated statistically significant declines in PROMs compared with preoperative baselines. A subset of patients exceeded MCID thresholds, indicating clinically meaningful donor-site morbidity in some cases. These findings underscore the importance of informed graft selection and highlight the need for further long-term evaluation.

Background: The Lauge-Hansen classification is commonly used for ankle fractures but demonstrates poor interobserver reliability when based on radiographs alone. This study was conducted to determine whether the addition of computed tomography (CT) improves observer agreement and influences surgical planning.

Methods: A retrospective analysis was conducted on patients with operatively treated ankle fractures. Five masked observers (2 orthopaedic surgeons and 3 orthopaedic surgery residents) classified fractures using the Lauge-Hansen system in 2 sessions: first with radiographs alone and then with radiographs in combination with CT. Interobserver agreement was assessed using Cohen kappa and Fleiss kappa, whereas consistency of each observer's classifications between radiograph-only and CT-assisted sessions was also evaluated. Changes in fracture classification and treatment plans following CT evaluation were also recorded.

Results: A total of 145 patients were included. Interobserver agreement improved significantly with the addition of CT, increasing from κ = 0.464 (95% CI: 0.41-0.52) with radiographs alone to κ = 0.804 (95% CI: 0.76-0.85) with radiographs plus CT (P < .001). The use of CT led to a change in fracture classification in 73 to 80 cases across observers (50.3% to 55.2%), and treatment plans were revised in 69 to 75 cases (47.6% to 52.0%).Among these changes, decisions to fix the posterior malleolus increased from 41 to 64 cases after CT evaluation (Δ = 15.9%, 95% CI: 10.8%-22.7%, P = .008), and syndesmotic stabilization was newly planned in 36 to 59 cases (Δ = 15.9%, 95% CI: 10.8%-22.7%, P = .014), depending on the observer. These findings indicate that CT provided critical diagnostic details that influenced both classification and surgical decision making.

Conclusion: CT significantly improves the consistency of the Lauge-Hansen classification and can have a substantial impact on surgical decision making. CT imaging may be considered, especially when posterior malleolar or syndesmotic involvement is suspected; however, its impact on clinical outcomes remains uncertain.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used in management of type 2 diabetes mellitus (T2DM) and obesity. Beyond glycemic control, these agents may influence orthopaedic outcomes. This study aimed to assess the relationship between preoperative GLP-1 RA use and postoperative complications in T2DM patients undergoing operative ankle fracture repair.

Methods: A retrospective cohort study was conducted using the TriNetX database, identifying adult patients with T2DM who underwent operative ankle fracture repair from 2005 to 2024. Patients were stratified based on preoperative GLP-1 RA exposure within 180 days of surgery. Propensity score matching (1:1) was performed on demographics, medications, comorbidities, and laboratory values. Postoperative outcomes were analyzed in 3 domains: (1) medical complications within 90 days, (2) operative and implant-related complications from 90 to 180 days, and (3) health care utilization at 30, 90, and 180 days.

Results: A total of 1,107 patients were analyzed in each group after matching. After false discovery rate correction, GLP‑1 RA use was associated only with lower all‑cause mortality (odds ratio [OR] 0.33, 95% CI 0.16-0.67, adjusted P = .011; number needed to treat = 56) and higher fall‑related injuries (OR 1.32, 95% CI 1.12-1.57, adjusted P = .011; number needed to harm = 15). No significant differences were observed in infection, posttraumatic arthritis, persistent opioid use, and wound healing complications.

Conclusion: Preoperative GLP-1 RA use in T2DM patients undergoing operative ankle fracture repair may reduce postoperative all-cause mortality but increase fall-related injuries. These findings underscore a complex risk-benefit profile of GLP-1 RA therapy in orthopaedic care.

Background: Traditional methods of evaluating Hallux Valgus (HV) have limitations in assessing 3D deformity elements such as first metatarsal pronation and sesamoid subluxation. This study aimed to use coverage mapping (CM) to analyze surface interactions of the first metatarsophalangeal joint (MTPJ) and metatarsosesamoid joints in HV and control patients, correlating findings with visual analog scale (VAS) pain scores. We hypothesized that patients with HV would show decreased joint coverage, reflective of joint subluxation, and that these changes would correlate with higher VAS scores.

Methods: A distance mapping (DM) algorithm was applied to weightbearing computed tomography (WBCT) images from 44 symptomatic HV patients and 43 controls. Color-coded CMs were obtained from these distance measurements and were divided into quadrants for analysis. Regions showing joint space widths <5 mm indicated normal intraarticular coverage. VAS scores were obtained from the electronic medical record at the time of clinical assessment. Angular measurements were semiautomatically obtained, including the hallux valgus angle (HVA) and first metatarsal rotation angle (MRA). Statistical analyses included paired t tests, Wilcoxon tests, and regression models.

Results: CM revealed significant reductions in joint coverage in HV patients, particularly in specific quadrants of the first MTPJ and metatarsosesamoid joints. No association was found between CM features and VAS scores. Higher VAS scores were associated with younger age, lower MRA, and higher BMI.

Conclusion: 3D WBCT CM revealed significant subluxation and deviation in HV patients. VAS scores were influenced by demographic variables and metatarsal rotation, but not CMs, suggesting unique challenges beyond subluxation and pain. WBCT mapping generates hypothesis-generating visualizations of HV deformity; prospective studies are required before it can guide diagnosis or surgical planning.

Background: Talus fractures are rare injuries. To date, there is limited literature on outcomes after modern operative treatment of talus fractures. Many prior studies are limited by a small number of patients, limited follow-up, and include radiographic outcomes only. The purpose of this study was to report long-term patient-reported outcomes after operative treatment of talus fractures.

Methods: This was a retrospective cohort study of patients with a talus fracture treated surgically at a level 1 trauma center between 2008 and 2018, with a minimum of 5 years of follow-up.Detailed demographic, injury, and radiographic data were collected. Attempts were made to contact all patients for long-term follow-up to collect the Foot and Ankle Ability Measure (FAAM) patient-reported outcome score.

Results: One hundred twenty-eight patients met inclusion criteria and were successfully contacted for follow-up. The average length of follow-up was 10.4 years. There was a 47% rate of posttraumatic arthritis. Thirty-eight patients (30%) underwent unplanned reoperation, of which 12 (9%) were a salvage procedure (fusion, arthroplasty, or amputation). Median FAAM score at a mean of 10 years was 83 (interquartile range [IQR] 58-96). For patients who did not require a salvage procedure (fusion, arthroplasty, or amputation), the median FAAM score was 85 (IQR 63-96). In contrast, those who underwent a salvage procedure had a median FAAM score of 52 (IQR 36-65), representing significantly poorer function. In univariate analysis, factors associated with lower FAAM score included open injuries, higher Injury Severity Score (ISS), and elevated body mass index (BMI). Additional negative predictors included increased time to definitive surgery, presence of a subtalar dislocation, development of subtalar arthritis, undergoing any reoperation, and salvage procedures. Fracture location, Hawkins classification, development of avascular necrosis, age, reoperations excluding salvage procedures, presence of ipsilateral foot/ankle fractures, and duration of follow-up were not independently associated with FAAM score. In multivariate analysis, only undergoing a salvage procedure and increasing BMI and ISS remained associated with poorer FAAM scores.

Conclusion: In a large cohort of surgically treated talus fractures, long-term functional outcomes were better than anticipated, with a median FAAM score of 83 despite a 47% rate of posttraumatic arthritis and 30% reoperation rate. These results suggest that modern dual-approach surgical techniques may substantially improve patient prognosis compared with historical expectations.

Background: Traditional surgical fixation of ankle fractures with plates and screws carries risks such as wound complications, hardware prominence, and soft tissue irritation. Intramedullary (IM) fibular nailing provides a minimally invasive alternative with potentially lower complication rates. Although prior studies have examined the risk posed by fibular nailing to the peroneal tendons and nerves, data remained limited regarding its impact on other adjacent structures especially the calcaneofibular ligament (CFL) and the articular cartilage of the distal fibula, structures whose injury could contribute to joint instability, persistent pain, or degenerative change.

Methods: This study assessed the risk and extent of damage to anatomical structures during IM nail fixation on 10 cadaveric lower extremities. Risks were categorized based on distances from the nail to the CFL, anterior talofibular ligament (ATFL), sural nerve (SN), superficial peroneal nerve (SPN), peroneus longus, peroneus brevis (PB), and articular cartilage: high-risk (0-5 mm), moderate-risk (5.1-10 mm), or low-risk (>10 mm).

Results: Macroscopic evaluation identified the CFL, ATFL, and PB as high-risk structures. The CFL was damaged in 3 of 10 specimens, ranging from 14% to 64% of its width. The average distances to the CFL (1.20 mm), ATFL (3.43 mm), PB (3.19 mm), and articular cartilage (3.45 mm) fell in the high-risk range, although no significant damage was observed to the articular cartilage, ATFL, SN, or SPN.

Conclusion: This study further confirms that IM fibular nailing is a generally safe and reliable option for treating ankle fractures. However, attention should be given to the potential for iatrogenic damage to high-risk soft-tissue structures, particularly the CFL and peroneal tendons. Although cartilage was always spared in this cadaveric study, its proximity warrants surgical caution.

Clinical relevance: These findings clarify the soft tissue risks associated with IM nailing and may provide guidance for orthopaedic surgeons and patient discussions, emphasizing the importance of proper technique to preserve soft tissues.

Background: There is increasing interest in the role of pronation as part of the deformity correction in hallux valgus (HV) especially with the advent of weightbearing computed tomography (WBCT) and percutaneous surgical techniques. This study aimed to assess the coronal rotation of the first metatarsal before and after percutaneous distal transverse osteotomy (Metaphyseal Extra-Articular Transverse and Akin Osteotomy [META]) using WBCT and to correlate these findings with clinical outcome scores.

Methods: A retrospective analysis of prospectively collected data from a single center of patients who underwent WBCT both before and after percutaneous distal transverse osteotomy for hallux valgus correction. The primary outcome was change in pronation on radiographic parameters; Hallux valgus angle, intermetatarsal angle, metatarsal pronation angle, alpha angle, sesamoid rotation angle, arthritis, and sesamoid position were assessed using coronal WBCT images. Secondary outcomes included pre- and postoperative clinical outcomes, including the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5 dimensions-5 levels (EQ-5D-5L), visual analog scale (VAS) and complication rates.

Results: Fifty-one feet from 34 patients (32 female, 2 male, mean age 60.3 ± 10.2 years) underwent META. Radiographic data were available for 94.4% of feet with a mean follow-up of 12.1 ± 3.2 months. There was a significant improvement across all radiographic parameters including pronation correction (P < .05). There was also a significant improvement in clinical foot function for all MOXFQ domains, EQ-5D-5L, and VAS pain outcomes (P < .05). The complication rate was 1.9%. There was no significant correlation of postoperative outcomes with radiographic pronation parameters. Regression analysis did not identify any radiographic or clinical variables that predicted change in the MOXFQ Index domain score.

Conclusion: Percutaneous distal transverse osteotomy for hallux valgus deformity can significantly correct coronal plane pronation and improve patient-reported outcomes, although correction of pronation was not significantly correlated with clinical improvement.