Benjamin M Conover, Matthew J Johnson, Robert G Frykberg, Katherine M Raspovic, Dane K Wukich
{"title":"Post-operative outcomes of talus fracture open reduction internal fixation in patients with diabetes mellitus.","authors":"Benjamin M Conover, Matthew J Johnson, Robert G Frykberg, Katherine M Raspovic, Dane K Wukich","doi":"10.1053/j.jfas.2024.09.003","DOIUrl":"https://doi.org/10.1053/j.jfas.2024.09.003","url":null,"abstract":"<p><p>Little is known regarding outcomes of talus fracture management among patients with diabetes mellitus. This study aimed to compare post-operative outcomes after open reduction and internal fixation for talus fracture in patients with complicated diabetes, uncomplicated diabetes, and patients without diabetes. We used the PearlDiver database to identify patients who underwent operative repair of talus fractures from 2009 to 2021. Complications were evaluated at 30-days, 90-days, and 1 year of surgery. As we performed multiple separate analyses, to minimize the risk of type 1 error we employed the Bonferroni correction for statistical significance (p< 0.017). The PearlDiver identified 5,232 patients with talus fracture that underwent open reduction internal fixation. Stratified by diabetes status, the \"complicated diabetes,\" \"uncomplicated diabetes,\" and \"no diabetes\" groups contained 223, 418, and 4591 patients, respectively. Reoperation, acute kidney injury, and myocardial infarction were increased among diabetes patients compared to non-diabetes patients, irrespective of diabetes severity within 3 months of surgery. Furthermore, patients with complicated diabetes were more likely to develop sepsis and wound disruption compared to their non-diabetes counterparts within 3 months. While not statistically significant, complicated diabetes patients were diagnosed with talar non-union at higher rates compared with non-diabetes patients. Further analysis may reveal a clinically significant discrepancy in non-union between these groups. Complicated diabetes is associated with significantly higher risk of multiple adverse events following talus fracture repair. LEVEL OF CLINICAL EVIDENCE: 3.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical and Radiological Outcomes of combined Arthroscopic Microfracture and Mesenchymal Stem Cell Injection Versus Isolated Microfracture for Osteochondral Lesions of the Talus: A Meta-Analysis of Comparative Studies.","authors":"Michele Mercurio, Roberto Minici, Giovanna Spina, Erminia Cofano, Domenico Laganà, Filippo Familiari, Olimpio Galasso, Giorgio Gasparini","doi":"10.1053/j.jfas.2024.08.011","DOIUrl":"10.1053/j.jfas.2024.08.011","url":null,"abstract":"<p><p>We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment of distal third tibial fractures with anterior soft tissue compromise through the posterolateral approach: Distal Third Tibial Fractures via the Posterolateral Approach.","authors":"Xiaoliang Yang, Xu Zhang, Caixia Liu, Liming Zhang, Fan Wu, Qiang Shen, Yadong Yu","doi":"10.1053/j.jfas.2024.09.002","DOIUrl":"10.1053/j.jfas.2024.09.002","url":null,"abstract":"<p><p>Distal third tibial fractures associated with anterior soft tissue compromise are a predictor of more complications and poor prognosis. The study aimed to introduce the treatment of such fractures through the posterolateral approach. From March 2020 and January 2022, 32 patients with distal third tibial fractures were plated through the posterolateral approach due to concurrent closed anterior soft tissue compromise. There were 30 male and 2 female patients with the mean age of 33 years (range, 20-53 years). The reduction quality of diaphyseal fractures was good (n=30) and acceptable (n=2). The reduction quality of articular fragments was anatomic (n=21), good (n=6), and fair (n=1). All anterior soft tissue injuries healed without surgical intervention. Follow-ups lasted 28 months (range, 25-34 months). The mean dorsiflexion of the injured and uninjured ankles were 17.8°±5.4° and 24.5°±6.6°, respectively (P<0.05). The mean plantar flexion of the ankles were 42°±8.8° and 46°±12.9°, respectively (P>0.05). The mean inversion of the injured and uninjured ankles were 15°±13.3° and 19°±12.4°, respectively (P<0.05). The mean eversion of the injured and uninjured ankles were 27.8°±16.9° and 32.9°±14.3°, respectively (P>0.05). The mean American Orthopaedic Foot and Ankle score was 90 (range, 68-100). Distal third tibial fractures with anterior soft tissue compromise can be plated through the posterolateral approach, resulting in good functional outcomes and minimum complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manasa L Kadiyala, Matthew T Kingery, Raymond Walls, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol
{"title":"Effect of patient age on fifth metatarsal fracture pattern, management, and outcomes.","authors":"Manasa L Kadiyala, Matthew T Kingery, Raymond Walls, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol","doi":"10.1053/j.jfas.2024.09.001","DOIUrl":"10.1053/j.jfas.2024.09.001","url":null,"abstract":"<p><p>Patients with 5th metatarsal (MT) fractures encompass a broad age distribution. This study evaluated the impact of age on the differences in clinical outcomes and management of these fractures. This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital system with a 5th MT fracture over a 10-year period. Patients were stratified into groups of younger than 65 years old and equal to or greater than 65 years old. Initial and successive radiographs were reviewed, and fractures were categorized as Zone 1, Zone 2, Zone 3, Shaft, Neck, or Head fractures. 2,461 patients with 5th MT fractures were evaluated. Patients who did not follow up after initial evaluation in the emergency department or urgent care were excluded. Among 2,020 patients with mean follow-up of 1.03 years who met inclusion criteria, 76.2% were younger than 65 years and 23.8% were greater than or equal to 65 years. There was a significant difference in fracture type between groups as older patients were more likely to sustain metatarsal neck fractures but less likely to sustain Zone 1 base fractures (p < 0.05). There was no difference in time to clinical healing (p = 0.108) or time to radiographic union (p = 0.367) for all fractures between age groups. In conclusion, older patients sustain different 5th metatarsal fracture patterns compared to younger patients. However, despite the differences in age, there was no evidence for any difference in clinical and radiographic outcomes between groups.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mila Scheinberg, Ting Dan Zhang, John Galloway, Juan Campos, Swathi Kalluraya, Marc Bernstein, Ashish Shah
{"title":"Weight changes following Achilles debridement with flexor hallucis longus transfer: A retrospective analysis.","authors":"Mila Scheinberg, Ting Dan Zhang, John Galloway, Juan Campos, Swathi Kalluraya, Marc Bernstein, Ashish Shah","doi":"10.1053/j.jfas.2024.08.018","DOIUrl":"10.1053/j.jfas.2024.08.018","url":null,"abstract":"<p><p>Obesity poses a growing concern, with global predictions estimating over half the population to be overweight or obese by 2030 (1). While prior research has extensively explored the impact of obesity on hip and knee surgeries, a notable gap persists in understanding weight changes following foot and ankle procedures. This retrospective study focuses on the relationship between Body Mass Index (BMI) and Achilles debridement with flexor hallucis longus (FHL) transfer. Despite prevailing research on the adverse effects of obesity on orthopedic outcomes, few studies examine the reciprocal influence of surgeries on weight. A retrospective analysis of 136 patients undergoing primary Achilles debridement with FHL transfer was conducted. Data encompassing BMI, demographic information, and medical comorbidities were extracted from electronic medical records (EMRs). A clinically meaningful BMI change was considered as a 5 % variation. Inferential statistics in the form of analysis of variance, t-test, and linear regression were employed for data analysis. Among the 136 patients in the study, no statistically significant BMI changes were noted up to two years after surgery (p = 0.9967). While obesity remains a significant factor in foot and ankle surgery complications, our study suggests that Achilles debridement with FHL transfer does not induce significant weight changes. Further research exploring factors influencing weight changes and varying outcomes across demographics is warranted. LEVEL OF EVIDENCE: III.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Pedowitz, Sarah J Ingwer, Ryan Rigby, Andrew Rosenbaum, Oliver Hauck, Anthony N Khoury
{"title":"Native anterior talo-fibular ligament tensile characteristics compared to allograft, suture tape, and copolymer augmentation elements: A biomechanical study.","authors":"David Pedowitz, Sarah J Ingwer, Ryan Rigby, Andrew Rosenbaum, Oliver Hauck, Anthony N Khoury","doi":"10.1053/j.jfas.2024.08.016","DOIUrl":"10.1053/j.jfas.2024.08.016","url":null,"abstract":"<p><p>Surgical augmentation methods have been introduced to the Modified Broström (MB) technique to support native anterior talo-fibular ligament (ATFL) healing and function. This study aimed to investigate the isolated biomechanical performance of common MB augmentation elements, including allograft, suture tape, and copolymer, compared to native ATFL. Six cadaveric feet were dissected, isolating the ATFL from all surrounding soft tissue. The fibula and talus were clamped on the testing frame so that the ligament was in line with the load cell. Six samples per augment group were fixed on a test frame with a gauge length of 20 mm to replicate ATFL length. All samples were pulled to failure at 305 mm/min. Biomechanical outcomes included stiffness, elongation, and ultimate load. Mean ± standard deviation was reported. Stiffness was highest for suture tape (246.4 ± 52.1N/mm), followed by allograft (114.2 ± 26.2 N/mm), native ATFL (78.6 ± 31.8 N/mm), and copolymer (9.4 ± 2.9 N/mm). Significant differences in stiffness were observed between all groups except when comparing ATFL stiffness to allograft (P = 0.086). Copolymer resulted in significantly larger elongation at ultimate load compared to native ATFL, suture tape, and allograft (P < 0.001). Elongation at ultimate failure was highest for copolymer (30.0 ± 8.7 mm) and significantly greater than all other groups (P < 0.001). Ultimate load was highest for suture tape (544.1 ± 59.7 N), followed by native ATFL (338.5 ± 63.7 N), allograft (308.3 ± 98.5 N) and copolymer (146.7 ± 8.9 N). Suture tape ultimate load was significantly greater than copolymer (P < 0.001). Isolated biomechanical data of augment materials can be utilized by foot and ankle surgeons when considering appropriate ligament augmentation options. Level of clinical evidence 5, controlled laboratory study.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reka Kovacs, Jun Min Leow, Mathew Smith, Phui Yuen Wong, Hisham Shalaby, John McKinley
{"title":"Increased Activity Level Following Total Ankle Replacement Results in Improved Patient Reported Outcomes.","authors":"Reka Kovacs, Jun Min Leow, Mathew Smith, Phui Yuen Wong, Hisham Shalaby, John McKinley","doi":"10.1053/j.jfas.2024.08.013","DOIUrl":"10.1053/j.jfas.2024.08.013","url":null,"abstract":"<p><p>While evidence highlights increased activity levels following total ankle replacement (TAR), the correlation between postoperative activity changes and ankle-surgery-specific patient-reported outcomes is unexplored. This retrospective cohort study investigates the effect of activity level changes on patient-reported outcomes, including the Manchester-Oxford Foot Questionnaire (MOXFQ) and patient satisfaction following TAR. Patient records from a single center performing TARs between January 2014 and February 2023 were reviewed alongside patient questionnaires completed preoperatively and at a mean follow-up of 44 ± 31 months postoperatively (range 6-134 months). Activity participation pre and postoperatively was assessed and correlated with MOXFQ scores. Data from 89 patients was available for analysis (mean age 72.3 ± 8.9 years [range, 48-92]). Postoperatively, 31 patients (35%) increased, 42 (47%) maintained, and 16 (18%) decreased their activity levels. The mean time to return to regular activity was 23.4 weeks. Preoperative MOXFQ scores were similar across all groups (increased: 74.03 ± 14.00; maintained: 73.6 ± 13.9; decreased: 77.0 ± 15.5; p = .71). All groups showed significant improvements in MOXFQ scores from preoperative to postoperative assessments (p < .05). Patients with increased activity levels showed greater MOXFQ improvements (-61.6 ± 19.0) compared to those with decreased activity levels (-38.3 ± 26.6) (p < .01). Following TAR, 82% of patients maintained or increased their activity levels. Patients with increased postoperative activity exhibited superior improvements in MOXFQ scores. These findings underscore the importance of promoting physical activity for optimal outcomes following TAR.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Investigation of The Effectiveness of Extracorporeal Shock Wave Therapy in Patients Diagnosed with Plantar Fasciitis: Comparison of Radial and Focus Applications.","authors":"Özge Tezen, Emine Esra Bilir, Hilal Buse Arslan, Emre Adıgüzel, Evren Yaşar","doi":"10.1053/j.jfas.2024.08.012","DOIUrl":"10.1053/j.jfas.2024.08.012","url":null,"abstract":"<p><p>The aim of the study was to investigate the effectiveness of radial and focus (extracorporeal shock wave therapy) ESWT treatment on pain, function and size of the calcaneal spur in patients with clinical and radiological diagnosis of plantar fasciitis. A total of 112 patients aged between 18 and 95 years, were divided into 2 groups; group 1, rESWT (2.4 bar 12 hz 2000 beats), group 2 received fESWT (0.14 bar 14 hz 1000 beats) 3 times a week for 3 weeks. All patients were evaluated using the Visual Analog Scale (VAS)-pain and Foot Function Index before and after the treatment, at 4 week and 12 weeks. Calcaneal spur size was measured radiographically in the patients before and after the treatment at the 12th week follow-up. According to our records, VAS scores were found to be similar between the groups before treatment and at follow-ups (all p > .05). In both groups, a significant decrease in VAS scores was found in the follow-ups compared to before treatment (p < .001). FFI total, pain, activity and disability scores were found to be similar between the groups before treatment and at follow-up (all p > .05). In both groups, a significant decrease in Foot Function Index scores was found in the follow-ups compared to before treatment (p < .001). Both of rESWT and fESWT were effective in plantar fasciitis treatment there were no significant difference between 2 modalities in long term.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}