Foot & Ankle Orthopaedics最新文献

{"title":"A Prospective Evaluation for a Possible Safe Skin Bridge in Elective Foot Surgery.","authors":"Graeme Moore, Nikiforos P Saragas, Paulo N F Ferrao","doi":"10.1177/24730114241256552","DOIUrl":"10.1177/24730114241256552","url":null,"abstract":"<p><strong>Background: </strong>In foot and ankle surgery, adequate surgical exposure often requires multiple incisions to be used near one another, thus creating a skin bridge. As the skin bridge becomes narrower, the wound edge vitality is potentially compromised and therefore the wound's ability to heal. The impact of local, host, and surgical factors on wound healing are well documented in the literature; however, little is known about the role of the skin bridge. The aim of this study is to determine if there is a recommendable safe skin bridge in elective foot and ankle surgery.</p><p><strong>Methods: </strong>A prospective study was performed on 56 patients with 60 feet who had elective foot surgery. The length of each incision and distance between the incisions were recorded. The wounds were assessed for complications at 2, 4, and 6 weeks after surgery. Patient demographics and host risk factors were documented.</p><p><strong>Results: </strong>The average incision length was 5.5 (range: 3-8.5) cm. The average skin bridge was 3.9 (range: 2-6.8) cm. Five (8.3%) of the 60 feet developed a wound complication. Four (80%) of these patients had a known comorbidity. Two patients had diabetes and 2 were smokers. The incidence of relevant comorbidities was 5.5% (n = 3) for patients without a wound complication (<i>P</i> < .001). Age did not differ significantly between patients with and without a wound complication. Patients with a wound complication had significantly longer incision lengths (<i>P</i> = .047). There was no significant independent association between skin bridge width and risk of wound complications (<i>P</i> > .05) with skin bridge widths of 2 cm or larger.</p><p><strong>Conclusion: </strong>In this relatively small cohort of 60 elective operative foot surgeries, we did not find increased wound complications in skin bridges 2 cm or larger, when meticulous surgical technique is practiced and host risk factors are optimized.</p><p><strong>Level of evidence: </strong>Level III, prospective case control study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241256552"},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330642","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}

{"title":"Reduction of the Posterior Malleolar Component of Trimalleolar Fractures Using Dry Arthroscopic Visualization and Manipulation by Working Through the Medial Malleolus Fracture.","authors":"Christopher Warburton, Olivia F Perez, Jacob L Cohen, Steven D Steinlauf","doi":"10.1177/24730114241258098","DOIUrl":"10.1177/24730114241258098","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241258098"},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261444","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}

{"title":"Percutaneous Fixation of Posterior Malleolar Fractures: A Contemporary Review.","authors":"Jafet Massri-Pugin, Sergio Morales, Javier Serrano, Pablo Mery, Jorge Filippi, Andrés Villa","doi":"10.1177/24730114241256371","DOIUrl":"10.1177/24730114241256371","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241256371"},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261405","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}

{"title":"Interphalangeal Resection Arthroplasty for the Prevention and Treatment of Diabetic Deformities and Ulcers of the Toes: A Systematic Review and Meta-analysis.","authors":"Kaissar Yammine, Joseph Mouawad, Mohammad Omar Honeine, Chahine Assi","doi":"10.1177/24730114241256373","DOIUrl":"10.1177/24730114241256373","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) are serious complications that induce a high risk of lower extremity amputations and mortality. Compared with the standard of care, few reports analyzed the outcome of surgical treatment mainly for diabetic toe deformities and ulcers. The aim of this study is to collate evidence on the outcomes of interphalangeal resection arthroplasty (IP-RA) in preventing and treating diabetic toe ulcers distal to the metatarsophalangeal joint.</p><p><strong>Methods: </strong>A search strategy has been developed including electronic databases from inception. Only ulcers distal to the metatarsophalangeal joints were included. Noninfected and infected ulcers were also included at any toe location (dorsal/side/plantar). Outcomes were defined as healing rate, time to heal, ulcer recurrence, ulcer transfer, postintervention infection, wound dehiscence, and additional surgeries including amputation. Proportional meta-analysis was conducted for frequency outcomes.</p><p><strong>Results: </strong>Six observational studies comprising 217 patients with 244 IP-RA procedures were included. The mean follow-up period was 23.4 ± 8.2 months. Weighted frequencies were as follows: healing rate (93.6%), ulcer recurrence frequency (4.3%), ulcer transfer frequency (15.4%), postoperative infection (10.5%), wound dehiscence (17.8%), revision surgery (5%), and amputation rate (3.4%). The mean healing time was 4.3 ± 1.8 weeks.</p><p><strong>Conclusion: </strong>This review suggests that IP-RA is effective in preventing and treating diabetic toe deformities and ulcers with a modest rate of complications for this specific and often challenging clinical presentation.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241256373"},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261403","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}

{"title":"Preoperative Degenerative Changes at the Tibial Sesamoid-Metatarsal Joint in Hallux Valgus: Association With Postoperative Patient-Reported Outcomes After Modified Lapidus Procedure.","authors":"Sophie Kush, Stone R Streeter, Agnes D Cororaton Jones, Brett Steineman, Scott J Ellis, Matthew S Conti","doi":"10.1177/24730114241256370","DOIUrl":"10.1177/24730114241256370","url":null,"abstract":"<p><strong>Background: </strong>Degenerative changes at the sesamoid-metatarsal joints (SMJs) may be a source of pain following hallux valgus surgery. The aims of this study were to describe degenerative changes at the SMJs on weightbearing computed tomography (WBCT) scans and, secondarily, investigate their association with 1-year patient-reported outcome scores following a modified Lapidus procedure for hallux valgus. We hypothesized that reduced joint space in the SMJs would correlate with worse patient-reported outcomes.</p><p><strong>Methods: </strong>Fifty-seven hallux valgus patients who underwent a modified Lapidus procedure had preoperative and minimum 5-month postoperative WBCT scans, and preoperative and at least 1-year postoperative PROMIS physical function (PF), pain interference, and pain intensity scores were included. Degenerative changes at the SMJs were measured using distance mapping between the sesamoids and first metatarsal head on preoperative and postoperative WBCT scans. The minimum and average distances between the first metatarsal head and tibial sesamoid (tibial-SMJ) for each patient preoperatively and postoperatively were measured. Sesamoid station was measured on WBCT scans using a 0 to 3 grading system. Linear regression was used to investigate the correlations between minimum preoperative and postoperative tibial-SMJ distances and 1-year postoperative PROMIS scores.</p><p><strong>Results: </strong>The median minimum and average tibial-SMJ distances increased from 0.82 mm (interquartile range [IQR] 0.40-1.03 mm) and 1.62 mm (IQR 1.37-1.75 mm) preoperative to 1.09 mm (IQR 0.96-1.23 mm) and 1.73 mm (IQR 1.60-1.91 mm) postoperative (P < .001 and P < .001), respectively. In a subset of patients with complete sesamoid reduction, we found an association between preoperative minimum tibial-SMJ distance and 1-year postoperative PROMIS PF scores (coefficient 7.2, <i>P</i> = .02).</p><p><strong>Conclusion: </strong>Following the modified Lapidus procedure, there was a statistically significant increase in the tibial-SMJ distance. Additionally, in patients with reduced sesamoids postoperatively, reduced preoperative tibial-SMJ distance correlated with worse PROMIS PF scores.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241256370"},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261440","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}

{"title":"Auditing the Representation of Female Athletes in Sports Medicine Research: Achilles Repair.","authors":"Michael Braman, Cooper Root, Ian Harmon, Rachel Long, Lisa Vopat, Bryan Vopat, Ashley Herda","doi":"10.1177/24730114241255360","DOIUrl":"10.1177/24730114241255360","url":null,"abstract":"<p><strong>Background: </strong>Establishing evidence-based recommendations specific to female athletes has been overlooked in sports medicine. Achilles tendon rupture is one of the most common musculoskeletal injuries, occurring in 15 to 55 per 100 000 people annually. Differences in injury rates could be due to hormonal effects, as estrogen receptors have been identified in tendons along with decreased tendon strain based on oral contraceptive use. The primary purpose of this study was to audit the representation of female athletes in the literature regarding Achilles repair.</p><p><strong>Methods: </strong>An electronic search was performed using PubMed to identify articles related to Achilles repair using the protocol by Smith et al. Studies were assessed by population, size, athletic caliber, study impact, research theme, and menstrual status.</p><p><strong>Results: </strong>Female representation across all studies was 1783 of 10 673 subjects (16.7%). Composition of included studies was predominantly mixed-sex cohorts with 131 of 169 (77.5%) included studies. Within mixed-sex cohort studies, the total representation of female athletes was 1654 of 8792 participants (18.9%). Thirty-two studies were male only, constituting 1540 participants, whereas 3 studies were female only composed of 86 athletes. Importantly, the disparity between male and female representation worsened as the athletic caliber of the study population increased, with 5.0% female representation in studies with professional athletes. No study collected data related to menstrual status and its potential relationship to Achilles rupture or postoperative outcomes.</p><p><strong>Conclusion: </strong>Mixed-sex cohort studies underrepresented female athletes, and male-only cohort studies were more common than female-only studies. These findings indicate a need for increased representation of female athletes as well as acknowledgment of menstrual status in research related to Achilles repair. Future studies should focus on representation of female athletes and data collection related to sex-specific hormones, hormonal contraceptive use, and menstrual status to improve treatment of Achilles tendon ruptures for female athletes.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241255360"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199549","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}

{"title":"Displacement after Open vs Saw-Based Minimally Invasive Medial Displacement Calcaneal Osteotomy: A Cadaveric Study.","authors":"Motasem Salameh, Sereen Halayqeh, Arielle Richey Levine, Mostafa M Abousayed, Raymond Hsu, Brad Blankenhorn","doi":"10.1177/24730114241255350","DOIUrl":"10.1177/24730114241255350","url":null,"abstract":"<p><strong>Background: </strong>Medial displacement calcaneal osteotomy (MDCO) is routinely used in hindfoot valgus realignment. Minimally invasive surgery (MIS) calcaneal osteotomies have been reported to be as safe and effective compared to open techniques. The aim of this cadaveric study was to compare the amount of medial tuberosity displacement obtained with fine-cut saw-based MIS vs open MDCO techniques.</p><p><strong>Methods: </strong>Eight matched cadaveric specimens had one side randomly assigned to either open or MIS MDCO. The contralateral limb was then assigned to the alternative osteotomy. The amount of medial displacement provided by the osteotomy was measured manually using a flexible metric ruler and radiographically on standardized axial calcaneal radiographs.</p><p><strong>Results: </strong>Manual measurements showed that a mean displacement of the MIS osteotomy was 7.9 mm compared with 8.7 mm for the open technique (<i>P</i> = .36). Radiograph measurement showed a mean displacement of the MIS osteotomy was 7.1 mm compared with 7.4 mm for the open technique (<i>P</i> = .83). No significant difference was found on manual and radiographic measurement of medial displacement between MIS and open MDCO.</p><p><strong>Conclusion: </strong>In a cadaveric model, we found similar magnitude of calcaneal tuberosity displacement using fine-cut saw-based MIS and open techniques for medial displacement calcaneal osteotomies.</p><p><strong>Level of evidence: </strong>Level V, cadaveric study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241255350"},"PeriodicalIF":0.0,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199556","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}

{"title":"Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review.","authors":"Hye Chang Rhim, Jason M Schon, Raylin Xu, David Nolan, Jiyong Ahn, Kelly Short, Lew C Schon","doi":"10.1177/24730114241255136","DOIUrl":"10.1177/24730114241255136","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241255136"},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141177177","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}

{"title":"Intraosseous Schwannoma of the Phalanx of the Left Third Toe: A Case Report.","authors":"Andrea Iglesias Ruiz, Xavier Llorens Martinez, Raul Figa Barrios, Andrea Rodriguez Fernandez","doi":"10.1177/24730114241255358","DOIUrl":"10.1177/24730114241255358","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241255358"},"PeriodicalIF":0.0,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157391","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}

{"title":"Association of Radiographic Soft Tissue Thickness With Revision Total Ankle Arthroplasty Following Primary Total Ankle Arthroplasty: A Minimum of 5-year Follow-up.","authors":"Kevin A Wu, Albert T Anastasio, Alexandra N Krez, Katherine M Kutzer, James K DeOrio, Mark E Easley, James A Nunley, Samuel B Adams","doi":"10.1177/24730114241255351","DOIUrl":"10.1177/24730114241255351","url":null,"abstract":"<p><strong>Background: </strong>The incidence of primary total ankle arthroplasty (TAA) is rising, with a corresponding increase in revision surgeries. Despite this, research on risk factors for revision TAA following primary TAA remains limited. Radiographic soft tissue thickness has been explored as a potential predictor for outcomes in hip, knee, and shoulder arthroplasty, but its role in TAA has not been assessed. This study aimed to assess the predictive value of radiographic soft tissue thickness for identifying patients at risk of requiring revision surgery following primary TAA.</p><p><strong>Methods: </strong>A retrospective study was conducted on 323 patients who underwent primary TAA between 2003 and 2019. Radiographic measurements of soft tissue thickness were obtained from preoperative radiographs. Two novel radiographic measures of soft tissue thickness were developed and assessed (tibial tissue thickness and talus tissue thickness). Clinical variables including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, diabetes, smoking status, primary diagnosis, and implant type were recorded. Logistic regression analysis was used to assess the predictive value of soft tissue thickness and BMI for revision TAA.</p><p><strong>Results: </strong>The rate of revision surgery was 4.3% (14 of 323 patients). Patients requiring revision had significantly greater tibial tissue (3.54 vs 2.48 cm; <i>P</i> = .02) and talus tissue (2.79 vs 2.42 cm; <i>P</i> = .02) thickness compared with those not requiring revision. Both the tibial tissue thickness (odds ratio 1.16 [1.12-1.20]; <i>P</i> < .01) and the talus tissue thickness (odds ratio: 1.10 [1.05-1.15]; <i>P</i> < .01) measurements were significant predictors of revision TAA in multivariable logistic regression models. However, BMI was not a significant predictor of revision TAA. The two metrics demonstrated excellent interrater reliability.</p><p><strong>Conclusion: </strong>Greater soft tissue thickness was a better predictor of revision TAA compared with BMI. These findings suggest that radiographic soft tissue thickness may be a valuable tool for assessing the risk of the need for revision TAA following primary TAA. Further research is needed to validate and explore the potential impact on clinical practice.</p><p><strong>Level of evidence: </strong>Level III, comparative study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241255351"},"PeriodicalIF":0.0,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157219","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}