Foot & Ankle Orthopaedics最新文献

{"title":"Comparison of Complication Rates and Surgical Costs for Total Ankle Replacements Performed in the Outpatient vs Inpatient Setting","authors":"Devon Nixon, Hyunkyu Ko, Brook Martin","doi":"10.1177/2473011424S00054","DOIUrl":"https://doi.org/10.1177/2473011424S00054","url":null,"abstract":"Introduction/Purpose: Increasing data has highlighted the safety and cost-effectiveness of outpatient hip, knee, and shoulder arthroplasty. However, limited evidence – mainly small, single institution case series – has explored complication rates and costs between outpatient and inpatient total ankle arthroplasty (TAA) surgeries. Methods: Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent TAA based on CPT coding. Patients on Medicare HMO, under age 65, and dual-eligible patients were excluded. Within this dataset, we compared surgeries performed in the outpatient versus inpatient setting. We compared groups based on readmission, all-complication, and infection rates within 1-year of TAA using logistic regressions controlling for age, sex, race, and comorbidity. To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher complication rates and costs among patients treated in the inpatient setting. Results: In total, 8,281 total ankle arthroplasty cases were identified (outpatient: 5,524 and inpatient: 2,757. Compared to inpatient cases, outpatient TAA surgeries were performed on younger, healthier (as assessed by Charlson Comorbidity Index (CCI) scores) patients who were more likely to be female (p < 0.001). In logistic regression analyses, outpatient TAA cases had lower readmission, all-complication, infection, mortality, and device-associated complication rates (p < 0.001) as compared to inpatient surgeries. Further, outpatient surgeries had sizable cost reductions compared to inpatient surgeries (p < 0.001). Conclusion: TAA performed in the outpatient setting appears to have less complications and decreased cost compared to inpatient procedures – though inpatient surgeries were presumably riskier as they were performed on older patients with increased co-morbidities. When clinically appropriate, though, TAA as an outpatient procedure appears to provide substantial reductions in cost with notable reductions in surgical risk.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"180 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fallacy of the “Learning Curve”","authors":"John T. Campbell, George B. Holmes, Christopher P. Chiodo, T. Clanton, Ellie Pinsker, Stefan Rammelt, Robert A. Vander Griend, Charles L. Saltzman","doi":"10.1177/24730114241247250","DOIUrl":"https://doi.org/10.1177/24730114241247250","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"312 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DARI Evaluation Syndesmosis","authors":"Victor Anciano, Campbell Edwards, Elive F. Likine, Ernest Rimer, Jonathan Holland, Brett Hayes","doi":"10.1177/2473011424S00057","DOIUrl":"https://doi.org/10.1177/2473011424S00057","url":null,"abstract":"Introduction/Purpose: Return to play (RTP) assessment and decision-making protocols are among the most discussed topics in sports medicine. Given the lack of validated guidelines, physicians and rehabilitation practitioners often rely on subjective functional evaluation to guide decisions to RTP. Biomechanical assessment using motion capture may be a useful strategy to evaluate an athlete’s post-injury functional status, and to estimate their ability to RTP with reduced risk of re-injury. The purpose of this case-study was to determine the efficacy of using marker-less 3D motion capture to provide an objective functional evaluation to tailor rehabilitation and aid RTP status for a patient who underwent syndesmotic fixation. Methods: In this case-study, a National Collegiate Athletic Association Division I collegiate football offensive lineman (Height: 1.96 m, Weight: 141 kg) performed a movement screen 5 weeks after left ankle syndesmotic fixation for purely ligamentous syndesmotic injury. Testing was performed at the anticipated time of RTP. After a standardized warm-up, the patient performed a series of 14 movements consisting of upper and lower extremity actions in all three planes of motion, including bilateral and unilateral lower extremity actions. Kinematic data was captured using an 8-camera marker-less motion capture system (MLMCS). Left and right joint-specific ranges of motion were compared for symmetry and to normative data produced by the MLMCS manufacturer. Results: The participant successfully performed all 14 movements without limitation. Ankle flexion was symmetrical during bilateral and unilateral squatting actions. However, left ankle (i.e., involved side) flexion was consistently less than right ankle flexion during more dynamic actions (Table 1). Despite the asymmetries, ankle range of motion was within normal ranges for both sides in all movements. From a performance standpoint, left-side jump heights were consistently less than the right-side efforts during the unilateral countermovement jump (left: 34.5 cm versus right: 41.1 cm; -16.0%) and consecutive hops (left: 29.5 cm versus right: 33.0 cm; -10.8%). Results were shared with the athletic trainer to focus rehabilitation efforts. The patient was able to fully RTP at 6 weeks. Conclusion: In this case-study, the patient successfully performed a movement screen without limitation at the time of RTP after left ankle syndesmotic fixation. A MLMCS detected kinematic differences that would be difficult to qualitatively recognize. Specifically, the patient expressed reduced ankle flexion and jumping performance on the operative side. No baseline screening was performed, but the observed asymmetries were consistent with what would be expected from the specific injury. Further research is needed to compare baseline measures to kinematic changes. These findings suggest that a basic movement screen using MLMCS can detect kinematic asymmetries after syndesmotic fixation. Table 1. Kine","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"65 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Talo-Fibular Ligament Tensile Properties Compared to Suture Tape, Allograft, and Copolymer Augmentation Elements: An Isolated Biomechanical Study","authors":"S. J. Ingwer, Ryan Rigby, Andrew Rosenbaum, Oliver Hauck, Anthony N Khoury, D. Pedowitz","doi":"10.1177/2473011424s00047","DOIUrl":"https://doi.org/10.1177/2473011424s00047","url":null,"abstract":"Introduction/Purpose: The modified Brostrom-Gould (MB) technique incorporates the inferior extensor retinaculum for added strength of anatomic Anterior Talo-Fibular Ligament (ATFL) repair. A major limitation of the MB technique is the inability to restore native ATFL biomechanics. Surgical augmentation methods have been introduced to address the MB insufficiency. The purpose of this study is to investigate the isolated biomechanical performance of common MB augmentation elements including suture tape, allograft, and copolymer compared to that of native ATFL. Methods: A total of 24 samples were tested in this study, n=6 in each group. An electromechanical testing system (Instron, Norwood, MA) was used to investigate the biomechanical performance of native ATFL, UHMW-PE suture tape (FiberTape™, Arthrex, Inc., Naples, FL), allograft (Semitendinosus Graft), and copolymer (FlexBand™, Artelon, Marietta, GA). Native ATFL ligaments were isolated from cadaver specimens (mean age: 63 years; range: 45-80), semitendinosus allografts were obtained from LifeNet Health (Jacksonville, FL). Samples measured 20 mm between rigid fixtures and oriented parallel with the long axis of the load cell to simulate worse-case loading. Samples were loaded to failure at 305 mm/min. Biomechanical outcomes included elongation, stiffness, and ultimate load to failure. One-way ANOVA was used to evaluate significant effects of all biomechanical variables. If significance was observed, post-hoc comparisons of augment element and native ATFL were performed with either Tukey or Holm-Sidak test (SigmaPlot,14.0, Systat). Results: Stiffness was greatest for the suture tape group (246.4±52.1N/mm) and least for the copolymer (9.4±2.9N/mm). Significant differences were observed between all augment elements except when comparing ATFL to allograft (p=0.086). Ultimate load was greatest for the suture tape group (544.1±59.7N) and least for the copolymer (146.7±8.9N). Analysis revealed that suture tape ultimate load was statistically greater than copolymer (p < 0.001, Fig.1). Elongation at ultimate failure was greatest for the copolymer group (30.0±8.7mm) and least for suture tape (2.6±0.5mm). Significant interactions were detected for all ultimate load comparisons except for allograft and ATFL (p=0.691), allograft and suture tape (p=0.537), and ATFL and suture tape (p=0.436). See Figure 1 for all data and statistical outcomes. Conclusion: ATFL augmentation elements require thorough evaluation for clinical adoption. Copolymer was 79% weaker in ultimate load and elongated 131% more than the native ATFL. Conversely, suture tape group exhibited 47% greater ultimate load and 82% less elongation at failure compared to ATFL. Clinically, these results suggest the copolymer maintains elastic properties incapable of supporting ATFL ligament healing under load. ATFL augmentation with suture tape offers advantageous post- operative load-sharing support and may allow return to preinjury level activity soon","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucose Lability and Complications in Diabetic Ankle Fractures","authors":"Ryan LeDuc, Michelle Shimizu, P. C. McGregor, Carlo Eikani, Kamran Hamid, Michael S Pinzur, Adam P Schiff","doi":"10.1177/2473011424s00070","DOIUrl":"https://doi.org/10.1177/2473011424s00070","url":null,"abstract":"Introduction/Purpose: Rotational ankle fractures in diabetics have long posed difficult clinical challenges, with several observational studies noting increased risk of complications and amputation following treatment of unstable ankle fractures in diabetics. Several treatment options exist, including non-operative management, external fixation, open reduction internal fixation, staged fixation, and fusion. Hemoglobin A1C produces a mean blood glucose level over a three-month period. There is mounting evidence that glucose variability may be an alternative predictor of complication profile in non-orthopedic procedures, as well as in the total joint arthroplasty literature. The purpose of this investigation is to retrospectively analyze complication rates for diabetics with rotational ankle fractures at a single institution and assess their association with both the hemoglobin A1C and glucose variability. Methods: After obtaining Institutional Review Board approval, all patients from 2015-2022 with a diagnosis of diabetes and ankle fracture were retrospectively identified based on ICD-9/ICD-10 codes. These charts were manually reviewed to determine fracture classification and treatment. For operatively and non-operatively managed ankle fractures, the patient’s hemoglobin A1C was recorded when available within 3 months of the date of injury. Glucose variability was calculated using a coefficient of variation. Results: Two-hundred patients were included for analysis, of which 29% (n=58) were treated non-operatively. The majority of surgically treated patients underwent acute ORIF (58%, n=116). 8.5% were treated with staged fixation, 3.5% with acute hindfoot fusion, and 1% with external fixation alone. The overall complication rate was 27.5% (n=55). There were no statistically significant differences in both A1C (7.81 +/- 1.89 vs 7.73 +/- 1.96) and glucose variability, as measured by the covariance of variation (0.23 +/- 0.15 vs 0.20 +/- 0.13) in patients who did and did not experience postoperative complications. Higher glucose variability did trend towards predicting complications, though not in a statistically significant fashion (OR=1.57, p=0.35). Conclusion: Ankle fractures in patients with diabetes pose a challenge for orthopedic surgeons, as evidenced by the high medical and surgical complication rate observed in this study and others. No statistical significance was found between higher A1C and complication rate or between glucose variability and complication rate. Further investigation on the impact of glucose variability on complication rates in a larger cohort of this patient population is warranted. Univariable logistic Regression Results for the association of the odds of post-operative complication with patient characteristics.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"53 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Hallux Rigidus Correction Surgery","authors":"Allison L. Boden, Stone R. Streeter, Seif El Masry, Grace DiGiovanni, Agnes D Cororaton, Matthew S. Conti, Scott Ellis","doi":"10.1177/2473011424s00058","DOIUrl":"https://doi.org/10.1177/2473011424s00058","url":null,"abstract":"Introduction/Purpose: In an ever-changing healthcare landscape, patient-reported outcomes (PROs) are becoming more important for reimbursement and evaluating the success of surgical procedures. Unfortunately, it is unclear which PROs correlate best with clinical improvement. The patient acceptable symptom state (PASS) asks the patient whether or not their outcome is acceptable at a particular post-operative time point. Recently, the use of this metric has gained traction within the foot and ankle literature. To our knowledge, this is the first study that aims to establish PASS thresholds for Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients who underwent operative intervention for hallux rigidus. Methods: A retrospective review of prospectively collected data within an institutional registry was performed. We identified 174 patients treated for hallux rigidus between February 2019 and March 2021 with at least 2-year post-operative PROMIS scores. Chart review was performed to obtain demographic information and to confirm the surgical procedures that were completed. Two-years post-operatively, patients answered two PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert- scale responses, which was collected along with pre-operative and 2-year post-operative PROMIS scores via the registry. After patient’s answers to the Satisfaction and Delighted-Terrible scales were recategorized into binary responses, PASS thresholds were determined using the maximum Youden Index and a 95% confidence interval was quantified using 2000 bootstrapped iterations. Differences in patient and surgical characteristics between patients who met or did not meet the PASS threshold were compared using independent samples t-test and Pearson chi square. Statistical significance was established at an alpha of 0.05. Results: There was excellent association between PASS thresholds and the PROMIS domains of Physical Function (48.6, AUC=0.82) and Pain Interference (52.1, AUC =0.86). Overall, 125/174 (71.8%) and 105/174 (60.3%) patients met the threshold for Physical Function (PF) and Pain Interference (PI), respectively. For the PF and PI domains, age, BMI, method of cheilectomy and use of Akin/Moberg osteotomy did not impact a patient’s likelihood of meeting the PASS threshold. For the PF domain and the PI domain stratified by the Delighted-Terrible scale, women were more likely to meet the PASS threshold than men (63.2% vs. 36.8%, p = 0.057 and 73% vs. 45%, p =0.023, respectively). Lastly, patients with a higher pre-operative PF score had a higher chance of meeting the PASS threshold (p < 0.001). Conclusion: Following operative intervention to treat hallux rigidus, pre-operative PROMIS scores were strongly associated with a patient’s likelihood of meeting the PASS threshold. After surgical intervention for hallux rigidus, less than 75% of the patients felt their outcome was acceptable; however, the PASS threshold for PF was lower","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"272 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological Heatmap of Tarsometatarsal Capsule Locations: A Cadaveric Study","authors":"Bedri Karaismailoğlu, M. Peiffer, Fernando Raduan, Julian Hollander, Ashley Knebel, John Y Kwon, S. A. Esfahani, Christopher P. Miller","doi":"10.1177/2473011424S00089","DOIUrl":"https://doi.org/10.1177/2473011424S00089","url":null,"abstract":"Introduction/Purpose: Minimal invasive proximal metatarsal osteotomy (PMO) offers a successful approach for addressing metatarsus adductus while avoiding exposure of all metatarsals, thereby reducing the risk of complications such as wound infections and non-unions. An important hurdle is the absence of direct visualization for precise osteotomy placement. Staying within the tarsometatarsal (TMT) capsule enhances the chances of better union due to improved blood supply, although operating outside the capsule can aid in correcting more significant deformities. Despite having a macroscopic understanding of anatomical locations through specimens, there has been a lack of prior reports on their mapping in fluoroscopic images. Developing such maps could significantly improve the navigational skills of surgeons. This study aims to present heatmaps that illustrate the positions of distal attachments of TMT capsules. Methods: A total of nine specimens below the knee, devoid of any prior bone or joint abnormalities, were thawed a day prior to the experiments. After dissecting the dorsal skin, neurovascular structures, and tendons, only the bones and capsules remained. Flexible wires were placed alongside the distal edges of TMT capsules, encompassing the 1st, 2nd, 3rd, and 4th tarsometatarsal joints. This arrangement aimed to make the paths of these capsules visible when observed through X-ray imaging. The wires were then securely attached to the structures using a soft tissue adhesive. Fluoroscopy images were captured, including a calibration marker of a known diameter, in addition to taking macroscopic photographs. The specific coordinates of these structures were marked in a three-dimensional space within specialized 3D software. Subsequently, these coordinates were imported into a custom-designed Python script crafted for the purpose of generating heatmaps. Results: The heatmaps were successfully produced encompassing all TMT capsules spanning from the 1st to the 4th, and these were overlaid onto an anteroposterior fluoroscopy image of the foot (refer to Figure 1). This gradient of colors serves as a visual representation of differing magnitudes, with red denoting the most prevalent areas of the distal attachment of the TMT capsule, while blue corresponds to lower occurrences. Conclusion: These heatmaps not only showcase the predominantly observed sites of distal TMT attachments, depicted in red, but also signify diverse deviations, identifiable by the presence of less frequent zones indicated in blue. Consequently, surgeons are advised to consider these findings while planning their osteotomies based on their preferred positions. By furnishing surgeons with an extensive heatmap that outlines potential tarsometatarsal capsule insertions, this research not only furnishes them with a dependable guiding resource but also establishes a foundation for more assured and prosperous minimally invasive midfoot fusion procedures. Figure 1: The heatmap of 1st to ","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"29 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effect of Diabetic Medications on Rates of Nonunion in Patients Undergoing Foot and Ankle Arthrodesis Treatments","authors":"Weston E. McDonald, Prudhvi Kodali, Chris Robinson, Joshua L. Morningstar, Christopher E. Gross, Daniel J. Scott","doi":"10.1177/2473011424s00064","DOIUrl":"https://doi.org/10.1177/2473011424s00064","url":null,"abstract":"Introduction/Purpose: Diabetes mellitus (DM) is known to negatively impact outcomes following surgical operations and increase the susceptibility of affected individuals to higher rates of nonunion, surgical site infection, ulceration, increased risk of amputation of the extremities, and various other perioperative complications. A number of in vitro studies suggest that the increase in undesired outcomes is largely secondary to the effects of diabetes-induced prolonged inflammation and advanced glycation end products (AGEs) on these patients' vascular systems and skeletal microarchitecture. However, there is a paucity of literature investigating the effects of blood glucose-regulating medications on the clinical outcomes of diabetic patients following fusion procedures. This study aims to determine the impact of commonly prescribed diabetic medications on bone health and bone healing following foot and ankle operations. Methods: A retrospective review was conducted of 114 diabetic patients undergoing ankle, hindfoot, or midfoot arthrodesis by one of two fellowship-trained foot and ankle orthopaedic surgeons from 2015-2022. Patients were identified by having undergone surgery via 27870, 27815, 27825, or 27835 CPT codes, as well as having been diagnosed with diabetes mellitus prior to or at time of surgery. Joints fused included the tibiotalar joint (n=45; 39.5%), subtalar joint (n=62; 54.4%), talonavicular joint (n=31; 27.2%), and calcaneocuboid (n=14; 12.3%). Data collected included demographics, medical history, diabetic medication, postoperative complications, readmission rates, and reoperation rates. 36 patient cases were noted to not have concurrent medications prescribed to control their diabetes, while the other 78 patient cases were concurrently prescribed either metformin (33 cases; 28.9%), insulin (19 cases; 16.7%), both metformin and insulin (18 cases; 15.8%), glipizides (11 cases; 9.6%), dulaglutides (7 cases; 6.1%), semaglutides (9 cases; 7.9%), and sitagliptins (8 cases; 7.0%). Results: The overall cohort was majority male (62.3%) with mean age 60.38 (range 31-76) years, mean BMI 34.00 (range 21.47- 61.38) kg/m2 and mean follow-up 1.90 (range .50-6.25) years. The cohort had a 27.2% superficial infection rate, 28.9% deep infection rate, 41.2% non-union rate, 47.4% reoperation rate, and a 14% 90-day readmission rate. Except for insulin-treated patients, who had significantly higher infection (insulin=45.9%, non-insulin=18.2%; p=.003) and deep infection rates (insulin=45.9%, non-insulin=18.2%; p=.003), there was no statistically significant difference in any outcomes by specific medication or any diabetic medication use. Patients with Charcot arthropathy (n=42) had significantly higher superficial infection (charcot=42.9%, non- Charcot=18.1%; p=.005), deep infection (Charcot=52.4%, non-Charcot=15.3%; p<.001), and 90-day readmission rates (Charcot=26.2%, non-Charcot=6.9%; p=.006). Conclusion: Our results indicate that patients on insuli","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Post-Operative Patient Reported Outcome Measurements Following Bunion Surgery: Modified Lapidus vs Minimally Invasive Techniques","authors":"BScMed Madeline Bhend, BS Chase Gauthier, MD Tyler Gonzalez, M. J. B. Md","doi":"10.1177/2473011424S00042","DOIUrl":"https://doi.org/10.1177/2473011424S00042","url":null,"abstract":"Introduction/Purpose: The modified Lapidus procedure (MLP) or a minimally invasive surgery distal transverse osteotomy (MISDTO) are acceptable surgical treatment options for hallux valgus. The current literature is evolving when comparing the effects of each procedure on patient reported outcomes and post-operative complications. The purpose of this study is to compare postoperative outcomes, time to weight bear, and patient reported outcomes using the Patient Reported Outcome Instrumentation System (PROMIS) for the MLP and MISDTO. Methods: This study retrospectively reviewed patients who underwent a MLP or MISDTO for hallux valgus correction at Prisma Health Midlands between February 2020 – February 2022. Data collected included: demographic data, postoperative outcomes, time to weight bear, and PROMIS scores, including Pain Interference (PI), Physical Function (PF), and Mobility scores. Paired Student’s T-Test and Wilcoxon Rank Sum test were used to compare continuous variables and Chi-Squared test for categorical variables. Results: A total of 81 patients undergoing MLP and 78 undergoing MISDTO were included in the study. Average follow-up for MLP and MISDTO patients was 53.7 and 43.4 weeks, respectively. MLP demonstrated significant improvement in PI (52.5 vs 56.8, P< 0.001) and Mobility (46.3 vs 43.4, P=0.044) scores, while MISDTO demonstrated a significant improvement in PI (48.8 vs 57.1, P< 0.001), PF (50.2 vs 44.9, P< 0.001), and Mobility (49 vs 42.8, P< 0.001) scores. MISDTO patients had significantly larger improvements in PI (7.6 vs 4.5, P=0.008), PF (5.3 vs 2.2, P=0.026), and Mobility (5.5 vs 2.9, P=0.02) compared to MLP patients. MISDTO patients had a significantly lower non-union rate (13.6% vs 2.6%, P=0.025), hardware failure rate (0% vs 9.9%, P=0.007), and time to weight-bear (2.2 vs 7.8 weeks, P< 0.001). Conclusion: Both MLP and MISDTO procedures are effective treatments for improving the pain and mobility issues associated with hallux valgus while maintaining patients’ function. MISDTO was found to improve patient reported outcomes significantly more than MLP, with a lower non-union rate, lower hardware failure rate, and shorter time to weight-bear. These findings suggest MISDTO is superior to MLP in improving patient reported outcomes and postoperative outcomes in the treatment of hallux valgus. Further study multicenter and long term outcome studies could be useful further evaluate these short term findings.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"162 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hawkins Sign of the Talus: The Impact of Patient Factors on Prediction Accuracy","authors":"Jarod T. Griffin, David C. Landy, Charles A Mechas, M. Nazal, Jeffrey A. Foster, Wyatt G S Southall, Maaz Muhammad, Carlos R. Sierra, Eric S. Moghadamian, Arjun Srinath, Arun Aneja","doi":"10.1177/2473011424s00071","DOIUrl":"https://doi.org/10.1177/2473011424s00071","url":null,"abstract":"Introduction/Purpose: Avascular necrosis (AVN) is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is considered to be a strong predictor of preserved talus vascularity. The study sought to assess the accuracy of the Hawkins sign in a large, contemporary cohort and assess factors associated with inaccuracy. Methods: A retrospective review of all talar neck fractures from a single level I trauma center from 2008 to 2016 was performed. The presence of Hawkins sign and AVN were determined based on ankle radiographs 8 weeks after injury and at final follow-up, respectively. Patients with less than 6 months follow-up were excluded. Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (C.I.) and associations were examined with Fisher’s exact testing. Results: In total, 137 talar neck fractures were identified with 105 having adequate follow-up. Hawkins sign was observed in 21 tali, 3 (14%) of which later developed AVN (95% C.I., 3 – 36%). In the remaining 84 tali without Hawkins sign, 32 (38%) developed AVN (95% C.I., 28 – 49%). Of the 3 tali that developed AVN following observation of Hawkins sign, all patients were smokers. There were no cases of AVN in non-smokers with Hawkins sign (P=0.21), and smoking was not associated with AVN in patients without Hawkins sign (41% vs 36%, P=0.82). Conclusion: Hawkins sign may not be a reliable predictor of preserved talus vascularity in all patients. We identified three patients with positive Hawkins signs who developed AVN, all of whom were smokers. Factors impairing microvascular blood supply to the talus may lead to AVN even in the presence of preserved macrovascular blood flow and an observed Hawkins sign. Close monitoring of select patients with Hawkins sign should be considered and further research is needed to understand the factors limiting Hawkins sign accuracy. Prognostic accuracy of the Hawkins sign in predicting talar AVN","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"258 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}