Foot & Ankle Orthopaedics最新文献

{"title":"A Comparison of Demographic Diversity Between Orthopaedic Surgery Residents and ACGME Foot and Ankle Fellows From 2007 to 2022.","authors":"Aditya Joshi, Andrew Kim, Nigel Hsu, Amiethab Aiyer, John M Thompson","doi":"10.1177/24730114241263056","DOIUrl":"10.1177/24730114241263056","url":null,"abstract":"<p><strong>Background: </strong>Academic medicine emphasizes the need to recruit a diverse workforce in graduate medical education. Orthopaedic surgery residency has demonstrated efforts to model program compositions with evolving US demographics. However, it remains unclear whether orthopaedic fellowships, particularly foot and ankle, also reflect these efforts.</p><p><strong>Methods: </strong>Using the publicly available Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book, a census of the gender and racial/ethnic identities of orthopaedic foot and ankle fellows, as well as active orthopaedic surgery residents, were compiled from 2007 to 2022. Linear trend analysis was conducted to evaluate the trends of orthopaedic residents and foot and ankle fellows, with a Pearson correlation for comparison.</p><p><strong>Results: </strong>Prior analysis demonstrated no significant change in sex and ethnic diversity of fellows from 2006 to 2015. The majority of foot and ankle fellows were White (31%-69%) and male (63%-88%). Linear analysis demonstrated growing diversity in female and non-White active orthopaedic surgery residents. Similarly, there was an increasing number of female foot and ankle fellows (0%-38%) reflective of the trend in orthopaedic residency (12%-20%); however, there was no significant change among racial/ethnic identities. Pearson correlation analysis between the trend of orthopaedic residency residents and foot and ankle fellows suggests moderate correlation among female, Asian, and \"Unknown\" racial/ethnic categories.</p><p><strong>Conclusion: </strong>The proportion of foot and ankle female fellows in ACGME-accredited fellowships has matched or exceeded the percentage of female orthopaedic residents. Despite increased diversity of orthopaedic surgery residents over the past 2 decades, ACGME-accredited foot and ankle fellowships do not yet reflect similar trends among racial/ethnic minorities.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241263056"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859497","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":"Minimally Invasive Surgery For Management of Bunionette Deformity (Tailor's Bunion) Using Fifth Metatarsal Osteotomies: A Systematic Review and Meta-Analysis.","authors":"Thomas L Lewis, Peter Lam, Yousif Alkhalfan, Robbie Ray","doi":"10.1177/24730114241263095","DOIUrl":"10.1177/24730114241263095","url":null,"abstract":"<p><strong>Background: </strong>There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review was to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction.</p><p><strong>Methods: </strong>A systematic review following PRISMA guidelines was undertaken. All clinical studies published in MEDLINE, Embase, PubMed, and the Cochrane Library Database from inception until December 2023 reporting on the use of percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool.</p><p><strong>Results: </strong>A total of 942 potential studies were identified, of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies (n = 14/18) used an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (American Orthopaedic Foot & Ankle Society ankle-hindfoot score and visual analog scale for pain) and radiologic outcomes (fourth-fifth intermetatarsal angle and fifth metatarsophalangeal angle). Complication rates ranged from 0% to 21.4%. The nonunion rate was 0% to 5.6%. Overall risk of bias was low to moderate. The most common complication was development of a hypertrophic callus that tended to resorb over time without needing further surgical intervention.</p><p><strong>Conclusion: </strong>The results of this systematic review must be considered in light of the methodologic limitations of the studies analyzed-including additional procedures performed at the same time as the bunionette correction, lack of comparative studies, and heterogeneity of the case series included. Despite these limitations, our review suggests that percutaneous techniques for bunionette deformity correction are generally clinically safe and associated with improvement in radiographic alignment and patient-reported outcome measures.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241263095"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859500","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":"Complications, Readmissions, and Reoperations in Outpatient vs Inpatient Total Ankle Arthroplasty: A Systematic Review and Meta-analysis.","authors":"Muzammil Akhtar, Daniel Razick, Deeksha Mamidi, Sonia Aamer, Fayez Siddiqui, Jimmy Wen, Sakthi Shekhar, Adithya Shekhar, Jason S Lin","doi":"10.1177/24730114241264569","DOIUrl":"10.1177/24730114241264569","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty (TAA) has primarily been performed in the inpatient setting. However, with the advent of fast-tracked joint arthroplasty protocols, TAA has slowly been shifting to the outpatient setting. Therefore, this systematic review aims to evaluate outcomes of outpatient TAA and compare them to inpatient TAA.</p><p><strong>Methods: </strong>A literature search was performed on October 23, 2023, in the PubMed, Embase, and CENTRAL databases using the PRISMA guidelines. Studies were included if they reported on outcomes of outpatient TAA or compared outcomes between outpatient and inpatient TAA. Pooled odds ratios (ORs) and mean differences were calculated using a random effects model. Quality assessment was performed using the MINORS criteria.</p><p><strong>Results: </strong>12 studies were included, with 4 outpatient-only and 8 outpatient-inpatient comparative studies. Patients in the outpatient group were relatively younger, had a lower body mass index, and had fewer comorbidities relative to the inpatient group. For outpatient vs inpatient TAA, the pooled complication rate was 2.6% vs 3.6%, readmission rate was 2.5% vs 4%, and reoperation rate was 3.6% vs 5.5%. We found significantly lower odds of complications (OR = 0.47, CI: 0.26-0.85; <i>P</i> = .01), readmissions (OR = 0.63, CI: 0.54-0.74; <i>P</i> < .00001), and reoperations (OR = 0.66, CI: 0.46-0.95; <i>P</i> = .03) in the outpatient vs inpatient group.</p><p><strong>Conclusion: </strong>Although this analysis is limited by the dominance of data included from a single study, we found that outpatient TAA was generally performed on lower-risk patients and was associated with lower rates of complications, readmissions, and reoperations compared with inpatient TAA.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241264569"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787755","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":"Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation.","authors":"Nicolas Fragnière, Maeva Kameni-Hekam, Amadou Cissé, Patrick Vienne","doi":"10.1177/24730114241265344","DOIUrl":"10.1177/24730114241265344","url":null,"abstract":"<p><strong>Background: </strong>Arthrodesis of the first metatarsophalangeal joint is an effective treatment of advanced hallux rigidus. Numerous options have been described for performing this intervention. The aim of this study was to evaluate the outcomes following a consistent surgical technique of joint preparation with hand tools and fixation with 2 crossed screws and a dorsal compression plate.</p><p><strong>Methods: </strong>Thirteen patients (16 feet) who underwent primary isolated arthrodesis of the first metatarsophalangeal joint between March 2019 and June 2021 were available for clinical, radiologic, and pedobarographic evaluation at a minimum of 12 months after surgery. American Orthopaedic Foot & Ankle Society scores, numerical pain rating scale, the radiologic hallux valgus and intermetatarsal 1-2 angles as well as the distribution of plantar pressure during gait were compared between the pre- and postoperative conditions.</p><p><strong>Results: </strong>After an average follow-up period of 26 months, union was achieved in all cases and the mean AOFAS score raised significantly by 39 points. All the patients were satisfied with the result. Only 1 patient complained of mild residual pain at walk. Hardware removal was performed in 2 cases. The mean hallux valgus angle dropped from 12.3 to 6.3 degrees. The mean postoperative dorsiflexion angle was 21.6 degrees. After the procedure, peak pressure was significantly higher beneath the first metatarsal head and heel, whereas pressure-time integral was significantly lower beneath the hallux and medial lesser toes.</p><p><strong>Conclusion: </strong>Arthrodesis of the first metatarsophalangeal joint with 2 crossed screws and a dorsal compression plate is a safe and effective treatment of advanced hallux rigidus. This procedure provides adequate pain relief and functional improvement of gait.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241265344"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787757","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":"Does FHL Tendon Transfer Alter the Outcome of Haglund Deformity Treatment by Using Debridement and Ostectomy in Patients Older Than 50 Years? A Single-Blinded Randomized Controlled Trial.","authors":"Amir Sabaghzadeh, Naser Ghanbari, Hediye Gholamshahi, Amir Mohammad Zakeri, Saman Shakeri Jousheghan, Mohammadamin Aslani, Maryam Khoshkholghsima, Mohmmad Movahedinia","doi":"10.1177/24730114241262783","DOIUrl":"10.1177/24730114241262783","url":null,"abstract":"<p><strong>Background: </strong>Chronic Achilles tendinopathy following Haglund disease is a common ankle condition that is difficult to manage. In this study, we will compare the clinical outcomes of debridement and ostectomy with and without FHL tendon transfer in treating Haglund deformity.</p><p><strong>Methods: </strong>Forty eligible patients aged >50 years who did not respond to conservative treatment were randomly divided into 2 groups for surgical approach: using flexor hallucis longus (FHL) tendon transfer (FHL group) or \"standard procedure\" (control group). The main surgical treatment included debridement and ostectomy. AOFAS and VISA-A scores were obtained from all patients pre- and postoperatively.</p><p><strong>Results: </strong>Twenty patients were assigned to each of the 2 groups and were observed for at least 1 year. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scores and the Victorian Institute of Sports Assessment self-administered Achilles (VISA-A) questionnaires scores improved more in the FHL group; however, the average difference in the change in scores did not reach the levels previously reported for minimal clinically important differences. Surgical complications and hallux function were not significantly different between the 2 groups.</p><p><strong>Conclusion: </strong>We found that FHL tendon transfer may improve the clinical outcome scores of Achilles tendon treatment in patients aged >50 years using debridement and ostectomy. However, tendon transfer increases the time of surgery and creates additional skin incisions, which may cause more short-term wound complications, and the significance of the differences in outcome improvement may not be clinically meaningful.</p><p><strong>Level of evidence: </strong>Level II, grade A recommendation.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241262783"},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11273563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787756","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":"Corrigendum to Midterm Clinical and Radiographic Outcomes of the Calcaneal Z-Osteotomy for the Correction of Cavovarus Foot.","authors":"","doi":"10.1177/24730114241263423","DOIUrl":"https://doi.org/10.1177/24730114241263423","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/24730114221146986.].</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241263423"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11184990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418526","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":"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}