Foot & ankle specialist最新文献

{"title":"Traumatic Periprosthetic Fractures Following Total Ankle Replacement: A Systematic Review and Proposed Classification.","authors":"Zachary P Hill, Joseph R Brown, Daniel DeGenova, Benjamin C Taylor, Robert Mendicino, Isaac Korb","doi":"10.1177/19386400241280357","DOIUrl":"10.1177/19386400241280357","url":null,"abstract":"<p><p>Total ankle replacements (TAR) are increasingly utilized, but postoperative traumatic periprosthetic fractures remain a rare yet challenging complication. This systematic review aims to address the gap in literature by proposing a comprehensive classification system for these fractures, considering implant stability, fracture location, and surrounding bone quality. A systematic review identified 13 cases from 9 studies meeting inclusion criteria. Fractures were categorized using the proposed Hill-Brown classification: Type A (talus or fibula), Type B (distal tibial component), and Type C (diaphysis/proximal tibial metaphysis). Implant stability was a key factor, with Type B fractures further classified as B1 (stable), B2 (unstable with adequate bone stock), and B3 (unstable with poor bone stock). Most fractures occurred at or near the distal tibial component (Type B), with implant stability largely dependent on fracture location and bone quality. Surgical fixation, particularly minimally invasive plate osteosynthesis (MIPO) with locking plates, was the preferred treatment for stable implants, showing low complication rates. Unstable implants often required revision TAR or conversion to arthrodesis. Surgical intervention is recommended following all traumatic periprosthetic fractures in the setting of a TAR. Bone quality, particularly in patients with rheumatoid arthritis or osteoporosis, significantly impacted treatment decisions. Our findings emphasize the importance of fracture location, implant stability, and bone quality in managing these fractures. Future multicenter studies are necessary to validate this classification system and refine treatment protocols.<b>Level of Evidence:</b> Level III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"295-304"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302492","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":"Early Experience With the Quantum Total Ankle Prosthesis.","authors":"Lauren M Christie, Terrence M Philbin","doi":"10.1177/19386400241310695","DOIUrl":"10.1177/19386400241310695","url":null,"abstract":"<p><p>The Quantum total ankle prosthesis is a newer Food and Drug Administration (FDA)-approved fourth-generation 2-component, fixed-bearing implant in its first-generation design. The purpose of this study was to evaluate early outcome data and present our initial experience with the Quantum implant with a minimum of a 1-year follow-up. A retrospective, single-centered chart and radiographic review was performed on all patients who underwent total ankle arthroplasty with the Quantum implant from December 2021 to August 2023. Implant survivorship, radiographic outcomes, clinical outcomes, and complications were evaluated. The survivorship for the implant was 100% for the tibial component and 91.67% for the talar component, respectively. Pre-operatively, there were 3 ankles with a coronal deformity greater than 10 degrees. Post-operatively, coronal plane deformity was 100% corrected into neutral alignment. This study is the first to report on short-term outcomes for the Quantum total ankle prosthesis. Our findings showed promising results of short-term implant survivorship with good clinical and radiographic outcomes.<b>Level of Evidence:</b> IV.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"311-318"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959595","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":"Five-Factor Modified Frailty Index as a Predictor of Complications Following Total Ankle Arthroplasty.","authors":"Lauren K Lewis, Daniel C Jupiter, Vinod K Panchbhavi, Jie Chen","doi":"10.1177/19386400231169368","DOIUrl":"10.1177/19386400231169368","url":null,"abstract":"<p><p>IntroductionAnkle arthritis adversely affects patients' function and quality of life. Treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA). A 5-item modified frailty index (mFI-5) has predicted adverse outcomes following multiple orthopaedic procedures; this study evaluated its suitability as a risk-stratification tool in patients undergoing TAA.MethodsThe National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed for patients undergoing TAA between 2011 and 2017. Bivariate and multivariate statistical analyses were performed to investigate frailty as a possible predictor of postoperative complications.ResultsIn total, 1035 patients were identified. When comparing patients with an mFI-5 score of 0 versus ≥2, overall complication rates significantly increased from 5.24% to 19.38%, 30-day readmission rate increased from 0.24% to 3.1%, adverse discharge rate increased from 3.81% to 15.5%, and wound complications increased from 0.24% to 1.55%. After multivariate analysis, mFI-5 score remained significantly associated with patients' risk of developing any complication (P = .03) and 30-day readmission rate (P = .005).ConclusionsFrailty is associated with adverse outcomes following TAA. The mFI-5 can help identify patients who are at an elevated risk of sustaining a complication, allowing for improved decision-making and perioperative care when considering TAA.Levels of Evidence:III, Prognostic.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"236-243"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9418933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Dehydration Increases the Risk of Extended Length of Hospital Stay Following Total Ankle Arthroplasty.","authors":"Theodore Quan, Matthew Magruder, Frank R Chen, Sean Tabaie, Matthew J Best, Amiethab Aiyer","doi":"10.1177/19386400231169367","DOIUrl":"10.1177/19386400231169367","url":null,"abstract":"<p><p>IntroductionThe effects of preoperative dehydration on outcomes following total ankle arthroplasty (TAA) remain unknown. Therefore, the purpose of this study is to evaluate the association between dehydration and postoperative complications for patients undergoing TAA.MethodsPatients undergoing TAA from 2007 to 2019 were identified in the National Surgical Quality Improvement Program (NSQIP) database. A preoperative serum blood urea nitrogen/creatinine (BUN/Cr) greater than 20 was used to define preoperative dehydration. Patients were stratified into 2 cohorts: patients who were dehydrated (BUN/Cr > 20) and patients without dehydration (BUN/Cr ≤ 20). In this analysis, various postoperative outcomes were assessed with bivariate and multivariate analyses.ResultsIn total, 1033 patients underwent TAA and had their serum BUN and Cr values recorded. For both BUN and Cr, the patients in this study had their serum values recorded a mean of 15 days before their surgery. A total of 588 patients (56.9%) did not have dehydration preoperatively and 445 patients (43.1%) were dehydrated. Following adjustment on multivariate analysis, an increased risk of extended length of hospital stay (odds ratio [OR] = 1.457; p = 0.024) was seen in the dehydrated group compared with those who were noted to be well hydrated.ConclusionAs fluid intake is one modifiable preoperative variable that can be easily monitored during elective procedures, it is important for physicians to be aware of patients who are dehydrated and adjust their fluids appropriately to optimize postoperative outcomes.Levels of Evidence:Level III: Retrospective cohort study.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"244-250"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9443087","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":"Patient Perceptions of Surgeon Reimbursement in Total Ankle Arthroplasty.","authors":"Austin B Mike-Mayer, Vishaal Sakthivelnathan, Akhil Sharma, Vinod K Panchbhavi, Jie Chen","doi":"10.1177/19386400231183602","DOIUrl":"10.1177/19386400231183602","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of total ankle arthroplasty (TAA) for ankle osteoarthritis has increased in the Medicare population by approximately 16.37% each year. This study examines the patient perception of orthopedic surgeon reimbursement for TAA by Medicare.</p><p><strong>Methods: </strong>A total of 78 patients were surveyed anonymously at 2 foot and ankle clinics within an academic health care setting. The surveys were given anonymously before the patients were seen by an orthopedic surgeon. Surveys were returned to office staff who placed them in a collection box to ensure confidentiality.</p><p><strong>Results: </strong>The average estimate of how much orthopedic surgeons should be reimbursed for TAA was $19 506 and the average estimate of how much orthopedic surgeons were actually reimbursed was $20 772. Fifty patients believed that orthopedic surgeons were under reimbursed, 9 believed that they were reimbursed appropriately, and 19 were unsure. Demographic variables such as age, sex, education level, income, and insurance status had no significant effect on the results.</p><p><strong>Conclusions: </strong>Most patients believed orthopedic surgeons are under reimbursed for TAA and that there is a lack of health care transparency regarding orthopedic reimbursement for TAA by Medicare.<b>Levels of Evidence:</b> Level V: Expert opinion.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"258-262"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9781142","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":"Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty.","authors":"Philip G Ghobrial, Carlo K Eikani, Daniel R Schmitt, Nicholas M Brown, Michael S Pinzur, Adam P Schiff","doi":"10.1177/19386400231207276","DOIUrl":"10.1177/19386400231207276","url":null,"abstract":"<p><p>Tranexamic acid has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty. The purpose of this study was to determine whether tranexamic acid use in patients with total ankle arthroplasty affects blood loss or overall complication rate. A retrospective chart review was conducted for 64 patients who underwent total ankle arthroplasty with (n = 32) and without (n = 32) intraoperative tranexamic acid from 2014 to 2023 at a single academic medical center. Recorded blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss, and complication rates were recorded and compared. There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference, hidden blood loss, or overall complications between the groups (all, P > .05). A lower rate of wound complications was observed in the tranexamic acid group, but the difference between each group was not statistically significant (P > .05). Tranexamic acid did not decrease blood loss during total ankle arthroplasty, as measured in our study. Tranexamic acid was not associated with any increase in overall complications. Based on our findings, tranexamic acid may be a safe intervention in total ankle arthroplasty, but further studies are needed to better elucidate its clinical impact.<b>Level of Evidence:</b> Level 3.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"263-268"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429763","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":"Rate of Infection and Causative Organisms in a Lateral Approach Total Ankle Replacement.","authors":"Yasser A Alhaddab, Rajat Mittal, Michael J Symes, Andrew P Wines","doi":"10.1177/19386400231184960","DOIUrl":"10.1177/19386400231184960","url":null,"abstract":"<p><p>BackgroundAlthough the rate of both superficial and deep infection in total ankle replacement (TAR) can reach up to 13% as reported in the literature, there is little information on the causative organisms, especially in laterally implanted prosthesis. This study aims to identify organisms causing infections to ultimately guide to better antibiotic prophylaxis.MethodsBetween September 2016 and April 2021, we retrospectively reviewed patients who had an infection after a lateral TAR. Cause of the infection, causative organisms, and implant survival were recorded.ResultsOut of 130 patients, 10 of 130 patients (7.6%) had a superficial infection whereas 3 of 130 patients (2.3%) had a deep infection. Staphylococcus and Pseudomonas species were found to be the most common. No significant difference was found between the type of plate used for fibula fixation regarding wound dehiscence.ConclusionsInfection after lateral TAR is generally polymicrobial in nature with Staphylococcus and Pseudomonas species being the most common.Level of Evidence:Level IV Case Series.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"251-257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9820676","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":"Does First Metatarsal Pronation Correct Itself With Metatarsal-Sesamoid Reduction?","authors":"Paulo Carvalho, Holly Johnson, Ricardo Villar, Martim Pinto, Pedro Diniz, Miki Dalmau-Pastor","doi":"10.1177/19386400251340139","DOIUrl":"https://doi.org/10.1177/19386400251340139","url":null,"abstract":"<p><p>BackgroundIn the past few years, great importance has been given to coronal plane deformity and to pronation of the first metatarsal (M1) in hallux valgus. We believe that tensioning of the medial metatarsal-sesamoid ligament (MMSL) as a consequence of M1 medial displacement in relation to the sesamoids might be the main cause of M1 pronation. This study aimed to retrospectively evaluate if M1 pronation is corrected after an adequate M1 head reduction over the sesamoids, using the Minimally Invasive Chevron-Akin (MICA) technique.Material and MethodsWe retrospectively reviewed a series of consecutive patients with symptomatic hallux valgus deformity, who underwent surgical treatment with the MICA technique between November 2021 and July 2022. Patients' radiographic weight-bearing images were retrospectively evaluated for pre- and postoperative pronation and metatarsal-sesamoid relative positioning. M1 pronation was assessed and classified as described by Okuda et al. Pronation was considered to exist in types R and I, ie, every time there was not an angular shape of the M1 head. Satisfactory sesamoid reduction was considered when the lateral sesamoid was, at least, 50% covered by the metatarsal.ResultsNinety-one feet (67 patients) met the inclusion criteria. The mean age at the time of surgery was 57.9 years. Most patients underwent unilateral surgery [right foot, 24 (35.8%); left foot, 19 (28.4%)] with 24 patients (35.8%) undergoing bilateral surgery. Eighty-four feet (92.3%) had preoperative pronation. Among these, 54 feet (64.3%) had satisfactory positioning of the head over the sesamoids postoperatively and 30 feet (35.7%) did not. Of the 54 feet with satisfactory positioning, 51 (94.4%) did not show postoperative metatarsal pronation, while 3 (5.6%) did (P < .0001). Of the 30 feet with unsatisfactory reduction of the M1 head, 28 (93.3%) had postoperative pronation and 2 (6.7%) had no pronation (P < .0001).ConclusionAccording to our study, first metatarsal pronation is predominantly self-corrected when a satisfactory reduction of the head of M1 over the sesamoids is achieved, using the MICA technique. We hypothesize that pronation might be due to MMSL tensioning however further basic science and clinical studies using weight-bearing computed tomography and biomechanical evaluation are needed to confirm our findings.Level of Evidence:Level IV.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251340139"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192581","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":"Wound Complications of Rapide Vs Nylon Sutures in Foot and Ankle Surgery.","authors":"Jacob Priester, Austin Lee, Andrea Rincon, Samuel K Simister, Nicholas Denove, Grace Hernandez, Max Haffner, Christopher Kreulen, Eric Giza","doi":"10.1177/19386400251339932","DOIUrl":"https://doi.org/10.1177/19386400251339932","url":null,"abstract":"<p><p>BackgroundNylon sutures are the most commonly used sutures for closing surgical wounds and require a postoperative suture removal visit. Absorbable sutures improve patient satisfaction by circumventing these visits. The primary aim of this study is to analyze wound complication rates related to wound closure using nylon and polyglactin 910 (Vicryl Rapide, Ethicon, Cincinnati, Ohio) sutures in foot and ankle surgery.MethodsA retrospective cohort study was performed at an academic medical center between 2014 and 2020. Patients over 18 years old who underwent foot and ankle surgery with polyglactin 910 or nylon sutures were included in the study. Exclusion criteria included type I or II diabetes, active pregnancy, incarceration, and pre-existing infection. Patient demographic data, operation performed, and follow-up complications were collected for review. Descriptive statistics, bivariate logistic regression, data normalcy, and appropriate tests of significance were used to compare the rate of postoperative surgical site infections (SSIs) and wound dehiscence across the 2 groups.ResultsA total of 1242 patients met our criteria: 863 were closed with nylon sutures (69.5%) and 378 with polyglactin 910 (30.5%). There was no difference between wound complications (3.18% vs 3.69%, P = .645), wound dehiscence (1.35 vs 2.82%, P = .122), or unplanned return to operating room (infection 1.08 vs 0.587%, P = .353 and dehiscence, 0.811 vs 1.52%, P = .314) between suture types.ConclusionThis study demonstrates no significant difference in wound complication rates after foot and ankle operations between those closed with polyglactin 910 and nylon sutures. With the potential benefits to clinic efficiency and decreased patient burden with absorbable suture use, this suggests a role for polyglactin 910 suture closures in foot and ankle surgery.Level of Evidence:Level III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251339932"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192582","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":"Tibial Glomus Tumor: A Case Report and Literature Review of Unusual Orthopaedic Glomus Tumor Presentation.","authors":"Olivia Jagiella-Lodise, Joseph R Duff, Tyler M Goodwin, Austin G Hughes, Richard D Murray, Ryan T Voskuil","doi":"10.1177/19386400251326242","DOIUrl":"https://doi.org/10.1177/19386400251326242","url":null,"abstract":"<p><p>Glomus tumors are benign neoplasms that most commonly occur in a subungal location but may occur in the extremities in rare instances. The insidious nature of these tumors can prolong patients' symptoms as well as diagnosis, leading to a delay in treatment. Awareness of these unusual neoplasms and inclusion in the orthopaedic surgeons' differential diagnosis is necessary to ensure timely recognition and proper management of this niche patient population. This case report describes a pathology-confirmed glomus tumor within the soft tissue of the distal tibia that was successfully treated with mass excision.<b>Level of evidence:</b> <i>V, Case Report</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251326242"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063345","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}