Foot & Ankle International最新文献

{"title":"Retrograde Drilling, Ossoscopy, and Autologous Bone Grafting: An Alternative Technique for Treatment of Osteochondral Lesion of the Talus Stage 2 and 3 in Adults.","authors":"Thorsten Huber,&nbsp;Alexander Schwertner,&nbsp;Robert Breuer,&nbsp;Christoph G Charwat-Pessler,&nbsp;Björn Rath,&nbsp;Ernst Orthner","doi":"10.1177/10711007231162825","DOIUrl":"https://doi.org/10.1177/10711007231162825","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. There are various surgical methods. A generally valid, stage-dependent therapeutic algorithm does not exist. The aim of our study is to show long- term results of an alternative technique that combines retrograde drilling, debridement performed under arthroscopic visualization, and autologous bone grafting.</p><p><strong>Methods: </strong>The surgical technique was performed in 24 patients with medial or lateral OLTs, and the data were analyzed retrospectively. In our technique, the affected subchondral bone was overdrilled retrogradely and resected under arthroscopic visualization (ossoscopy) without violating the cartilage. The resulting defect was filled with autologous bone from the medial tibia metaphysis. Outcome parameters were the numeric rating scale (NRS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion (ROM). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed and a possible correlation with the clinical outcome scores was calculated. Data concerning complication rates were also collected.</p><p><strong>Results: </strong>The mean surface size of the OLTs was 0.9 ± 0.3 cm². The mean follow-up was 89 months. The AOFAS score improved significantly from 57.7 points preoperatively to 88.8 points at the final follow-up (<i>P</i> < .0001). The pain value measured by the NRS decreased significantly from 8 to a pain level of 2. ROM improved in 37.5% of the patients for dorsiflexion and 29.2% for plantarflexion. There were no significant correlations between the MOCART score and the AOFAS score or the pain value on NRS.</p><p><strong>Conclusion: </strong>Retrograde drilling, ossoscopy, and autologous bone grafting for OLTs is a promising technique with good long-term results. The patients' satisfaction rate, especially in OLT stages 2 and 3, was excellent.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"488-496"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy.","authors":"Tayfun Bacaksız, İhsan Akan, Cemal Kazimoglu","doi":"10.1177/10711007231165308","DOIUrl":"10.1177/10711007231165308","url":null,"abstract":"<p><strong>Background: </strong>The study aimed to compare the outcomes of combined calcaneocuboid arthrodesis and split anterior tibialis tendon transfer (SPLATT) procedure to isolated SPLATT surgery for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP).</p><p><strong>Methods: </strong>Forty-one ambulatory CCP with 56 equinovarus feet, with positive flexor withdrawal reflex test results, were studied. The average age was 9.1 ± 3.2 years (range 3-22). Patients were assigned into 2 groups based on the surgical procedures. Patients in group 1 underwent isolated SPLATT surgery, whereas patients in group 2 underwent the SPLATT procedure combined with calcaneocuboid arthrodesis. All feet were followed for at least 12 months after surgery. Patients were evaluated preoperatively and at the most recent follow-up visit. The hindfoot positions were assessed using Chang's criteria, the functional outcomes were assessed using Kling's criteria, and the ambulatory levels were assessed using the Gross Motor Function Classification System (GMFCS).</p><p><strong>Results: </strong>Patients were followed for an average of 30.4 ± 14 (range 14-84) months. We found no difference between the groups in Chang's scoring (<i>P</i> = .550), better clinical outcomes (<i>P</i> = .034) according to the Kling criteria in SPLATT with calcaneocuboid fusion group, and postoperative GMFCS levels better in the SPLATT with calcaneocuboid fusion group (<i>P</i> = .025).</p><p><strong>Conclusion: </strong>In this retrospective comparative study to treat children with spastic equinovarus feet, patients who had the SPLATT procedure combined with calcaneocuboid arthrodesis generally resulted in better functional outcomes compared to isolated SPLATT surgery in spastic equinovarus foot.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"528-538"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Stepwise Minimally Invasive Sinus Tarsi Approach to Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: Technique Tip.","authors":"Johnny Rayes,&nbsp;Paul Sharplin,&nbsp;Peter Maalouf,&nbsp;Scott Willms,&nbsp;Andrew Dodd","doi":"10.1177/10711007231165765","DOIUrl":"https://doi.org/10.1177/10711007231165765","url":null,"abstract":"The calcaneus is the most commonly fractured tarsal bone in the setting of polytrauma, with a 17% prevalence in patients presenting with foot injuries.19 Displaced intraarticular calcaneal fractures (DIACF) can be highly disabling injuries if left untreated.21 Appropriate surgical management with open reduction and internal fixation (ORIF) has been associated with good outcomes regardless of fracture pattern, or patient characteristics.8,13 In particular, accurate subtalar anatomic joint reduction and restoring the Böhler angle are key features to improved functional outcomes and lower rates of secondary subtalar arthrodesis. However, ORIF can be difficult in complex cases with comminuted intercalary fragments.16 The extensile lateral approach (ELA) has been the gold standard for calcaneal ORIF because of the wide surgical exposure and ease of manipulation of fracture fragments.4 However, it has been associated with significant wound complications, limiting its advantage over nonoperative treatment in different trials.4,9,10 On the other hand, the sinus tarsi approach (STA) is gradually becoming the standard surgical approach for calcaneal ORIF.17 Recent data showed good functional and radiographic outcomes, with low morbidity and low rates of wound complications, making it one of the preferred surgical approaches among foot and ankle surgeons.7,11,20 However, the STA, with its narrow field of exposure, can represent a challenge to inexperienced surgeons dealing with complex intra-articular fractures of the calcaneus, leading to inferior quality of reduction.6 The current article will describe a step-by-step technical note to successful ORIF of DIACF using a minimally invasive STA. Surgical Technique","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"565-573"},"PeriodicalIF":2.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/3b/10.1177_10711007231165765.PMC10248302.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Endoscopic Partial Plantar Fasciotomy on Morphologic and Functional Properties of the Foot.","authors":"Finn Johannsen,&nbsp;Lars Konradsen,&nbsp;Philip Hansen,&nbsp;Signe Brinch,&nbsp;Janus Uhd Nybing,&nbsp;Michael Rindom Krogsgaard","doi":"10.1177/10711007231160741","DOIUrl":"10.1177/10711007231160741","url":null,"abstract":"<p><strong>Background: </strong>The lifetime risk of plantar fasciitis is 10%, and operative treatment in the form of endoscopic partial plantar fascia release are often performed in cases refractory for nonsurgical treatment. The effect of the operation on the biomechanical properties of the foot has only been sparsely studied.</p><p><strong>Methods: </strong>This is a prospective, observational study of 25 patients with plantar fasciitis, for a minimum of 3 months, verified by ultrasonographic scanning, who had endoscopic partial fasciotomy. A bony spur was resected if present. At the calcaneal insertion, the medial half of the central band of the plantar fascia was excised in full thickness. The biomechanical properties of the foot were evaluated before surgery and 12 months postoperatively.</p><p><strong>Results: </strong>Foot length increased 0.17 cm (<i>P</i> = .03), the width of the central zone 0.35 cm (<i>P</i> = .019), the modified arch index 0.05 (<i>P</i> = .032), and the Foot Posture Index 1.0 (<i>P</i> = .0014). There were no significant changes in rearfoot eversion angle, ankle dorsiflexion and jump distance, or in magnetic resonance imaging-measured 3D navicular position from pre- to postoperation, with or without loading, and no changes in ultrasonographically measured heel pad thickness. A tantalum bead (0.7-mm-diameter) was inserted during operation into the most proximal part of the released medial plantar fascia. Radiographs obtained few days postoperatively and 1 year later revealed no changes in the tantalum-calcaneus distance in supine position, but an increase from 48.3 to 50.7 mm (<i>P</i> = .045) in one-leg standing, suggesting a higher flexibility of the remaining fascia. Patients with a body mass index above and below 27.0 demonstrated no significant differences in any of the assessments at 12 months.</p><p><strong>Conclusion: </strong>There were minimal changes in the measured foot morphologic and functional properties at 1-year follow-up, after endoscopic partial plantar fascia release.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"415-423"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9843398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the Mayo Periprosthetic Joint Infection Risk Score for Total Ankle Arthroplasty.","authors":"Zijun Zhang,&nbsp;Bonnie Y Chien,&nbsp;Naudereh Noori,&nbsp;Jonathan Day,&nbsp;Cassandra Robertson,&nbsp;Lew Schon","doi":"10.1177/10711007231157697","DOIUrl":"https://doi.org/10.1177/10711007231157697","url":null,"abstract":"<p><strong>Background: </strong>Assessing patient's risk of infection is fundamental for prevention of periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA). The Mayo Prosthetic Joint Infection Risk Score (Mayo Score) is based on data from total hip and knee arthroplasty and has not been validated for application for TAA.</p><p><strong>Methods: </strong>A total of 405 consecutive TAA cases were followed for 6 months for PJI. Individual patients' Mayo Scores were calculated and analyzed with logistic regression and receiver operating characteristic (ROC) for predictability for PJI. A critical cut-off Mayo Score for patients at high risk of PJI was determined by best Youden index. Among the Mayo Score-defined high-risk patients, the contribution of different risk factors were compared between the PJI and non-PJI patients.</p><p><strong>Results: </strong>There were 10 cases of PJI (2.5%) among the 405 cases within 6 months after TAA. Of the 405 patients, the Mayo Scores ranged between -4 and 13 (median 2; interquartile range 0-5). The average Mayo Score was 2.5 ± 3.4 in the non-PJI patients and 7.7 ± 3.1 in the PJI patients (<i>P</i> < .001). Logistic regression showed that the probability of PJI increased with higher Mayo Scores (odds ratio 1.48, 95% CI 1.23-1.78). All but 1 PJI patients had a Mayo Score >5. The sensitivity and specificity were 90.0% and 84.3%, respectively, when a Mayo Score >5 was used as a criterion for high risk of PJI.</p><p><strong>Conclusion: </strong>This study demonstrated that the Mayo Score could similarly predict PJI risk after TAA as in total hip and knee arthroplasty. Data analysis suggests that a Mayo Score >5 could be a criterion for identifying high-risk patients for PJI, although further validation with a large number of PJI cases is necessary.</p><p><strong>Level of evidence: </strong>Level II, developing diagnositic criteria with consecutive cases.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"451-458"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9490765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Talar Neck Fractures With Body Extension and Risk of Avascular Necrosis.","authors":"Charles A Mechas,&nbsp;Arun Aneja,&nbsp;Mark R Nazal,&nbsp;Richard W Pectol,&nbsp;Chandler R Sneed,&nbsp;Jeffrey A Foster,&nbsp;Daria L Kinchelow,&nbsp;Matthew W Kavolus,&nbsp;David C Landy,&nbsp;Arjun Srinath,&nbsp;Eric S Moghadamian","doi":"10.1177/10711007231160751","DOIUrl":"https://doi.org/10.1177/10711007231160751","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to determine whether talar neck fractures with proximal extension (TNPE) into the talar body are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck (TN) fractures.</p><p><strong>Methods: </strong>A retrospective review of patients sustaining talar neck fractures at a level I trauma center from 2008 to 2016 was performed. Demographic and clinical data were collected from the electronic medical record. Fractures were characterized as TN or TNPE based on initial radiographs. TNPE was defined as a fracture that originates on the talar neck and extends proximal to a line subtended from the junction of the neck and the articular cartilage dorsal to the anterior portion of the lateral process of the talus. Fractures were classified according to the modified Hawkins classification for analysis. The primary outcome was the development of AVN. Secondary outcomes included nonunion and collapse. These were measured on postoperative radiographs.</p><p><strong>Results: </strong>There were 137 fractures in 130 patients, with 80 (58%) fractures in the TN group and 57 (42%) in the TNPE group. Median follow-up was 10 months (interquartile range, 6-18 months). The TNPE group was more likely to develop AVN as compared to the TN group (49% vs 19%, <i>P</i> < .001). Similarly, the TNPE group had a higher rate of collapse (14% vs 4%, <i>P</i> = .03) and nonunion (26% vs 9%, <i>P</i> = .01). Even after adjusting for open fracture, Hawkins fracture type, smoking, and diabetes, AVN still remained significant for the TNPE group as compared to the TN group with an odds ratio of 3.47 (95% CI, 1.51-7.99).</p><p><strong>Conclusion: </strong>We found a higher rate of AVN, subsequent collapse, and nonunion in patients with TNPE compared to isolated TN fractures.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"392-400"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9859964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Calendar.","authors":"","doi":"10.1177/10711007231173043","DOIUrl":"https://doi.org/10.1177/10711007231173043","url":null,"abstract":"","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"477"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9462015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Fusion of the First Metatarsophalangeal Joint and Pes Planus Deformity Correction.","authors":"James Chapman,&nbsp;Kieren Higginson,&nbsp;Anjani Singh,&nbsp;Siva Sirikonda,&nbsp;Andrew P Molloy,&nbsp;Lyndon Mason","doi":"10.1177/10711007231159098","DOIUrl":"10.1177/10711007231159098","url":null,"abstract":"<p><strong>Background: </strong>There has been scant investigation on the relationship between the distal aspect of the medial longitudinal arch and pes planus deformity. The aim of this study was to investigate whether the reduction and stabilization of the distal aspect of the medial longitudinal arch through fusion of the first metatarsophalangeal joint (MTPJ) can subsequently improve pes planus deformity parameters. This could be useful in both further understanding the role of the distal medial longitudinal arch in patients with pes planus and planning operative intervention in patients with multifactorial medial longitudinal arch problems.</p><p><strong>Methods: </strong>A retrospective cohort study was undertaken between January 2011 and October 2021, including patients undergoing first MTPJ fusion with a pes planus deformity on weightbearing preoperative radiographs. These were compared to postoperative images, and multiple pes planus measurements were taken for comparison.</p><p><strong>Results: </strong>A total of 511 operations were identified for further analysis, with 48 feet meeting the inclusion criteria. There was a statistically significant reduction identified between the pre- and postoperative measurements of Meary angle (3.75 degrees, 95% CI 2.9-6.47 degrees) and talonavicular coverage angle (1.48 degrees, 95% CI 1.09-3.44 degrees). There was a statistically significant increase between the pre- and postoperative measurements of calcaneal pitch angle (2.32 degrees, 95% CI 0.24-4.41 degrees) and medial cuneiform height (1.25 mm, 95% CI 0.6-1.92 mm). Reduced intermetatarsal angle was significantly associated with an increase in first MTPJ angle postfusion. Many of the measurements made were found \"almost perfectly\" reproducible by the Landis and Koch description.</p><p><strong>Conclusion: </strong>Our results demonstrate that fusion of the first MTPJ is associated with improvement of medial longitudinal arch parameters of a pes planus deformity but not to levels considered to be clinically normal. Therefore, the distal aspect of the medial longitudinal arch could, to some degree, be a feature in the pes planus deformity etiology.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"443-450"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9482281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks Associated With Posterior Ankle Hindfoot Arthroscopy Complications.","authors":"Karthikeyan Chinnakkannu,&nbsp;Nacime Salomao Barbachan Mansur,&nbsp;Natalie Glass,&nbsp;Phinit Phisitkul,&nbsp;Annunziato Amendola,&nbsp;John E Femino","doi":"10.1177/10711007231157714","DOIUrl":"https://doi.org/10.1177/10711007231157714","url":null,"abstract":"<p><strong>Background: </strong>The use of posterior ankle and hindfoot arthroscopy (PAHA) has been expanding over time. Many new indications have been reported in the literature. The primary objective of this study was to report the rate of PAHA complication in a large cohort of patients and describe their potential associations with demographical and surgical variables.</p><p><strong>Methods: </strong>In this IRB-approved retrospective comparative study, patients who underwent posterior ankle and/or hindfoot arthroscopy in a single institution from December 2009 to July 2016 were studied. Three fellowship-trained orthopaedic foot and ankle surgeon performed all surgeries. Demographic data, diagnosis, tourniquet use, associated procedures, and complications were recorded. To investigate a priori factors predictive of neurologic complication after PAHA, univariate and multivariable logistic regression was utilized. Where appropriate, sparse events sensitivity analysis was tested by fitting models with Firth log-likelihood approach.</p><p><strong>Results: </strong>A total of 232 subjects with 251 surgeries were selected. Indications were posterior ankle impingement (37%), flexor hallux longus disorders (14%), subtalar arthritis (8%), and osteochondral lesions (6%). Complications were observed in 6.8% (17/251) of procedures. Neural sensory lesions were noted in 10 patients (3.98%), and wound complications in 4 ankles (1.59%). Seven neurologic lesions resolved spontaneously and 3 required further intervention. In a multivariable regression model controlled for confounders, the use of accessory posterolateral portal was the significant driver for neurologic complications (odds ratio [OR] 32.19, 95% CI 3.53-293.50).</p><p><strong>Conclusion: </strong>The complication rate in this cohort that was treated with posterior ankle and/or hindfoot arthroscopy was 6.8%. Most complications were due to neural sensorial injuries (sural 5, medial plantar nerve 4, medial calcaneal nerve 1 ) and 3 required additional operative treatment. The use of an accessory posterolateral portal was significantly associated with neurologic complications. The provided information may assist surgeons in establishing diagnoses, making therapeutic decisions, and instituting surgical strategies for patients that might benefit from a posterior arthroscopic approach.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"385-391"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9490764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Talar Neck Fractures With Proximal Extension Are a Harbinger for Worse Radiographic Outcomes.","authors":"Heather A Vallier","doi":"10.1177/10711007231167350","DOIUrl":"https://doi.org/10.1177/10711007231167350","url":null,"abstract":"In this issue of FAI, Mechas et al3 reported their experience in treating talar neck fractures, describing talar neck fractures with proximal extension (TNPE). This subset of fractures, which extend proximally into the anterior aspect of the talar dome cartilage, occur commonly, and have not been previously characterized. Fractures with proximal extension have greater risk for osteonecrosis, talar dome collapse, and nonunion of the fracture, when compared to talar neck fractures (TN) contained within the neck proper. Prior reports on talar neck fractures have been limited to small, often single-institution, retrospective series of fractures. More recent studies have shared modern techniques and principles of provisional reduction, as indicated, and staged open reduction and internal fixation, often using dual surgical approaches.6-9 It is accepted that although the timing of definitive fracture fixation is not associated with development of osteonecrosis, various features of the initial injury are associated with damage to the arterial supply, and resultant risk of osteonecrosis. Some of these factors include open injuries, associated talar body fractures, and initial fracture displacement.1,2,6-9 The authors should be commended on providing a large series of fractures, treated at a single institution, for analysis. Although their work is retrospective, thus limited by sample heterogeneity, including patient demographics, comorbidities, and injury patterns, the treatment tactic was similar. They further offered a simple methodology of characterizing fractures based on plain radiography. More recently, many surgeons routinely obtain computed tomography scans in the evaluation and management of talus fractures, even for fractures that appear limited to the talar neck on plan radiography. Although apparently simple fracture pattens may not afford further detail on advanced imaging to alter the treatment plan, it is possible that the authors’ ability to discern TNPE with plain radiography would be enhanced with use of a computed tomography scan. Despite this, their method was corroborated by multiple, blinded surgeons agreeing on the fracture description. Prior literature has likely reported on talar neck fractures by combining those with and without proximal extension. The utility of a new, simple assessment of the initial fracture providing prognostic information is a valuable addition to our management of patients with these complex injuries. Notably, their report suffers from typical challenges of studying this population, generating low and inconsistent rates of follow-up. Their patients were assessed between 3 and 122 months following injury, with a median of 10 months and interquartile range of 6-18 months. For the primary outcome measurement of osteonecrosis, and the secondary outcomes of collapse and nonunion, a longer period of follow-up, minimum of 12-18 months, is more appropriate.6-9 It is probable that some patients would develop osteon","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 5","pages":"401-402"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10315850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}