bluuebunny/crossref_metadata_2025 huggingface dataset:
How to Approach Plantar Fasciopathy in Elite Athletes? A Scoping Review of the Literature
Authors: Bernasconi Alessio , Coppola Martina , Sgadari Arianna , Marasco Domenico , Mariconda Massimo
Published: November 2022

Category:

Sports; Hindfoot

Introduction/Purpose:

Plantar fasciopathy (PF) is a common orthopaedic condition which often affects athletes and limits their performance. Our aim was to conduct a scoping review of the literature in order to summarise the evidence provided so far in the management of PF in Elite Athletes and identify potential gaps in the current knowledge.

Methods:

This scoping review followed the six-stage methodological framework of Arksey and O'Malley and was registered in the Open Science Framework (10.17605/OSF.IO/48S3K). Pubmed, Scopus and Web of Science were used to identify elegible papers. After charting of data, studies were pooled into three categories: 1) epidemiological/diagnostic studies, 2) outcome research and 3) studies on the rupture of the plantar fascia. The modified Coleman Methodology Score (mMCS) was used to assess the quality of manuscripts included.

Results:

Out of 742 initial studies, 10 were selected (109 patients) including 8 Level IV and 2 Level V articles. In four studies (91 athletes), potential risk factors (i.e. pre-existent thickening of the fascia, spike shoes, varus hindfoot/knee alignment) were discussed. In three studies (6 athletes), focusing on plantar fasciitis, the non-surgical treatment led to a satisfactory but poorly- documented outcome. In three studies (12 athletes), the rupture of the fascia was treated conservatively with contrasting results, while surgery was performed only in 2 cases. The mean mCMS was 19 (range, 3 to 42), demonstrating overall poor methodology.

Conclusion:

The limited number of studies and their poor quality do not allow to define the gold standard treatment of PF in Elite Athletes. Until high-quality studies are provided, clinicians have to rely on the available literature regarding the non- professional or non-athletic population to make the best evidence-based decision.
Hindfoot Nail or Protibial Screw Fixation for Ankle Fracture: A Multi-Centre Study
Authors: Bethel Jordan L. , Najefi Ali-Asgar , Davies Monica , Gosney Eleanor , Patel Keval , To Christopher , Guryel Enis , McEwan Josephine , Buchan Stephanie , Northway Joseph , Quereshi Amir , Ahluwalia Raju
Published: November 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Multi-centre assessment of utilisation and outcomes of hindfoot intramedullary fixation (HFN) or fibula pro-tibial screw fixation (PTS) in complex ankle fractures.

Methods:

From January 2020 - June 2021, demographic data, co-morbidities, was collected on all patients undergoing HFN or PTS for an AO44 ankle fracture at three Major Trauma Centre's (MTC's) in the UK. Outcomes of interest included post-operative complications, Charlson-Co-morbidity-Index-Score (CCIS), weight-bearing status, peri-operative information, soft tissue management and post-operative complications were recorded, Radiographs were assessed for metalwork breakage and anatomical reduction (Pettrone Criteria).

Results:

77 patients were identified; 59 underwent HFN and 18 had PTS fixation. The mean age differed between techniques (80+-11.4 [HFN] vs. 66+-19.8 [PTS]) (p<0.001) and 10-year survival favoured patients undergoing PTS (30+-31.6% in the [HFN] and 55+-37.6%[PTS] (p<0.004). 17 (29%) HFN patients had diabetes compared with 7 (39%) PTS patients. 36 (61%) HFN's were open fractures, 7 (39%) PTS's were open fractures, differences in outcomes between primary closure/shortening/joint preparation and combined ortho-plastic management were noted in the HFN group.Time to full weight bearing was reduced in HFN vs. PTS (2.1+-3.1 vs. 8.0+-5.0) (p<0.001), only a minority of patients were allowed to WB immediately. 12 (27%) of patients with open fractures had post-operative complications compared with 5 (15%) of closed fractures. The mean Pettrone score for HFN was 1.3+-1.6 compared with 3.7+-0.6 for PTS, subgroup analysis showed Pettrone scores for open fractures treated with a HFN worsened(0.9 vs 2.3) (p=0.007).

Conclusion:

Comparing functional and outcome rates between the 2 techniques, PTS provides stable fixation, and a lower overall complication rates, with better radiological outcomes and expected survival. However, HFN is performed in frailer patients, with co-morbidities where early weight-bearing may be beneficial, accepting limited functionality and higher complication rate. Even though both techniques are designed for early mobility in the appropriate person this is not always realised, thus further studies are required to characterise which patients benefit most from each surgical technique.
Arthroscopic Evaluation of Subtle Syndesmotic Instability: Are We Pulling Correctly in the Coronal Plane?
Authors: Bhimani Rohan , Lubberts Bart , Hagemeijer Noortje , Zhao John Z. , Saengsin Jirawat , DiGiovanni Christopher W. , Guss Daniel
Published: November 2022

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

While the lateral hook test (LHT) has been widely used to arthroscopically evaluate syndesmotic instability in the coronal plane, it is unclear whether the angulation of the applied force has any impact on the degree of instability. The aim of this study was to determine if changing the direction of the force applied while performing the LHT impacts the amount of coronal diastasis observed in purely ligamentous syndesmotic injuries.

Methods:

In 10 cadaveric specimens, arthroscopic evaluation of the distal tibiofibular joint in the coronal plane was performed. Anterior and posterior third coronal plane diastasis were assessed in the intact state and repeated after sequential transection of the, 1) anterior inferior tibiofibular ligament (AITFL), 2) the interosseous ligament (IOL) and the 3) posterior inferior tibiofibular ligament (PITFL). In all scenarios, the lateral hook test (LHT) was performed under 100N of laterally directed force. Additionally, LHT was also performed under 1) anterior inclination of 15 degrees and 2) posterior inclination of 15 degrees in the intact and AITFL+IOL deficient state. One-way ANOVA with post hoc Tukey HSD was used to test for significant differences in coronal plane measurements between each stage of ligament transection, and to determine the effect of different directions of force application on coronal space measurements in the intact and AITFL+IOL transected states.

Results:

Compared to the intact state, the distal tibiofibular joint remained stable after transection of AITFL under laterally directed force with no angulation. However, after additional transection of the IOL, the syndesmosis became unstable in the coronal plane (p = 0.029 and 0.025 for anterior and posterior third diastasis, respectively). This instability worsened further with subsequent transection of the PITFL (p = <0.001). Moreover, there was no statistical difference in anterior and posterior-third coronal diastasis in both intact and AITFL+IOL deficient states under neutral, anterior, and posteriorly directed force(p-values ranging from 0.816-0.993 and 0.396-0.80,respectively). However, in AITFL+IOL transected state, posteriorly directed forces resulted in greater diastasis than neutral or anteriorly directed forces.

Conclusion:

Angulation of the applied force ranging from 15 degrees anteriorly to 15 degrees posteriorly during intraoperative LHT has no effect on coronal plane measurements in patients with subtle syndesmotic instability. On the other hand, posteriorly directed forces result in more sizable diastasis, potentially increasing their sensitivity. When arthroscopically evaluating subtle syndesmotic instability, clinicians should assess coronal diastasis with the hook angled 15 degrees posteriorly.
Use of Flexible Carbon Fiber Insoles for Hallux Rigidus: A Randomized Controlled Trial
Authors: Bhimani Rohan , Sornsakrin Pongpanot , Vrolyk Michael A. , Lubberts Bart , Guss Daniel , DiGiovanni Christopher W. , Waryasz Gregory R.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Rigid orthotics play an important role in the non-operative management of hallux rigidus. However, compliance can be low due to pain and discomfort. We hypothesized that patients with hallux rigidus who wear a carbon fiber orthotic that maintains some flexibility will report reduced pain, higher physical function, and higher compliance rates when compared with a more traditional, rigid Morton's extension insole.

Methods:

Four males and nine females (mean age of 56 years; range 35-79) diagnosed with unilateral 1st metatarsophalangeal arthritis were included in this randomized controlled trial. Participants randomly received either bilateral flexible carbon fiber insoles (VKTRY) (n=7) or unilateral Morton's extension insole (n=6). Outcome measures included patient self-reported compliance, comfort rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires Global Health, Pain Interference, v1.0 Pain Intensity, v2.0 Physical Function, and v1.0 Depression. Participants filled out questionnaires at the onset of the study and at two, six, and twelve weeks follow-up.

Results:

Compared to Morton's extension insole, use of flexible carbon fiber insole led to reduction of pain interference score at 6 and 12 weeks (median ∆∆ -9.5 vs 0.0 p=0.015; and median ∆∆ -15.1 vs -2.3 p=0.015, respectively), as well as reduction of pain intensity score at 6 and 12 weeks (median ∆∆ -11.9 vs -2.3 p=0.018; and median ∆∆ -11.9 vs -2.3 p=0.010, respectively). The compliance rate in flexible carbon fiber insole group was 100% at 2, 6 and 12 weeks, compared to 83%, 83% and 50% in the Morton group. In addition, patients wearing carbon fiber insoles experienced higher comfort levels (p-values ranging from <0.001 to p=0.007). There were no differences between the comparison groups at 2, 6, and 12 weeks in terms of the global health, physical function, and depression scores.

Conclusion:

Patients diagnosed with hallux rigidus may benefit from wearing more flexible carbon fiber insoles as compared to the traditionally used rigid orthotic insoles, such as the Morton's extension. Such inserts may better balance the need for mechanical shielding of the hallux while allowing some motion as, for example, occurs in the interphalangeal after fusion procedures.
Intramuscular Haemangioma of Abductor Hallucis Muscle: A Rare Case Report
Authors: Boedijono Dimas R. , Luthfi Andi Praja Wira Yudha
Published: November 2022

Category:

Other

Introduction/Purpose:

Haemangioma is a slow growing benign soft tissue tumor and its presentation in the foot is rare. Intramuscular haemangioma (IH) are usually found before 30 years of age, with gender predominance is still inconclusive.

Methods:

An 18-year-old woman came with pain and mass in the left foot for the past 3 years. Magnetic Resonance Imaging (MRI) of the left foot shown a heterogenous multilobulated mass, with previously thought originated from flexor digitorum brevis (FDB) muscle. Wide excision was performed.

Results:

Intraoperative findings showed that the mass actually originated from abductor hallucis muscle. Post-operative histopathological findings confirmed the diagnosis of cavernous-type of intramuscular haemangioma.

Conclusion:

Literature research identified very few cases of intramuscular haemangioma of the foot. Wide excision of the muscle is a feasible surgical treatment option.
Early Complications Following Minimally Invasive Surgery for Hallux Valgus in Patients with and without Diabetes
Authors: Cafruni Virginia M. , Novillo Hinostroza Matias A. , Parise Ana C. , Conti Leonardo A. , Carrasco Nelly M. , Villena Daniel S. , Sotelano Pablo , Gala Santini Araujo Maria
Published: November 2022

Category:

Diabetes; Bunion; Midfoot/Forefoot

Introduction/Purpose:

Diabetes mellitus (DM) is a chronic disease with a high worldwide prevalence. People with DM are more likely to develop complications compared to non-diabetic patients undergoing foot and ankle surgery. Currently, orthopedic surgery tends to use minimally invasive surgery (MIS), this resource is used to successfully solve forefoot deformities such as Hallux Valgus (HV). So far there is no evidence enough on this type of surgery and its complications in people with DM. The objective of this study is to determine the types and rates of early complications of elective MIS procedure for hallux valgus in a population of diabetic patients (DBT) compared to a control group of non-diabetic patients (NDBT).

Methods:

This retrospective study was carried out at our institution between October 2017 and August 2020. During the study period, 874 feet were operated on with MIS technique. All diabetic adults with a diagnosis of HV who underwent percutaneous correction surgery with distal metaphyseal osteotomy and a minimum follow-up of 6 months were included. All diabetic patients who underwent surgery had controlled diabetes with glycosylated hemoglobin less than 7%.For each DBT patient, we randomly selected two aged-matched patients +-1 year without DM as controls. In bilateral surgery, only the first operated foot was taken into account. Patients with previous foot surgery, open lesions or history of previous ulceration, Charcot's neuropathy, metatarsophalangeal osteoarthritis, peripheral vascular disease, and incomplete clinical history were excluded. Complications were recorded and defined as any deviation from the normal postoperative course.

Results:

A total of 75 patients were analyzed, 25 DBT and 50 NDBT. The follow-up was 10.8 months (6-48). There were no significant differences in demographic characteristics except for the body mass index and the Charlson comorbidity index, both of them were higher in the DBT group (p = <0.001). The complication rate was 18% (n = 9) in NDBT and 24% (n = 6) in DBT patients (p=0.553). There were also no significant differences in the different types of complications. Table 1. It is important to highlight that 7 of 9 complications of the NDBT group required a new surgical intervention (5 osteosynthesis extractions, 1 pseudarthrosis treatment and 1 toilette). In the DBT group, superficial infections were successfully treated with oral antibiotics.

Conclusion:

This would be the first study that specifically evaluates complications in diabetes patients with elective hallux valgus MIS correction. In our results, diabetic patients have not been associated with a higher rate of complications compared to non- diabetic patients.
3-Dimensional Analysis of First Tarsometatarsal Joint after First Metatarsal Osteotomy with Weightbearing CT (WBCT)
Authors: Cain Jarrett D. , Stolle Jordan T. , Siegler Sorin
Published: November 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

The pathology of the bunion deformity consists of deformities in the axial, coronal, and sagittal planes of the first metatarsal and its articular surface with the medial cuneiform. While weightbearing radiographs have been utilized for assessment of these deformities, such methods have limitations with regard to image magnification, patient position, and superimposition of bone alignments. With advances with weightbearing computed tomography (WBCT), evaluation of the 3- dimensional components of the first metatarsal along with its proximal articular surface can be assessed with greater precision. This study aims to observe the effect of the midshaft osteotomy on the alignment of the tarsometatarsal joint in three dimension

Methods:

Ten feet in 10 subjects underwent midshaft first metatarsal osteotomies. Weight-bearing (using a load equivalent to body weight) CT scans with .3mm cubic voxel size using an original loading device preoperatively and postoperatively were collected from each of the subjects in neutral standing position. Scans were segmented, and 3D renderings of the medial cuneiform, first metatarsal, and the first phalanx were also generated from the segmentations followed by definition of reference frames to evaluate changes in the metatarsal in relationship to the medial cuneiform. (Fig.1)

Results:

The measurements of the rotational parameters showed greater changes in the sagittal plane postoperatively with dorsiflexion of the first metatarsal relative to the medial cuneiform at the first tarsometatarsal joint (p<0.05).(Fig.2) Post-operative changes in the coronal plane and axial plane with relationship of the first metatarsal to the medial cuneiform were noted. Distance mapping showed a significant increase in surface-to-surface distance at the dorsal tarsometatarsal joint post-operatively with a reduced distance at the inferior portion of the tarsometatarsal joint. (Fig.3).

Conclusion:

Based on the results of the study, midshaft osteotomies of first metatarsal can cause increased dorsiflexion in the sagittal plane, significant eversion in the coronal plane, and external rotation in the axial plane at the tarsometatarsal joint. Distance mapping analysis on WBCT images identified differences in surface-to-surface interaction of the first metatarsal and the medial cuneiform
Is the Diagnosis of 5th Metatarsal Fracture Type Consistent? An Inter-Observer Reliability Study
Authors: Chapman James , Choudhary Zain A. , Gupta Shubhi , Davies Thomas , Airey Grace L. , Mason Lyndon W.
Published: November 2022

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Treatment pathways of 5th metatarsal fractures are commonly directed based on fracture classification, with Jones types for example, requiring closer observation and possibly more aggressive management. Our primary objective was to investigate the reliability of assessment of subtypes of 5th metatarsal fractures by different observers.

Methods:

Patients were identified from our prospectively collected database. We included all patient referred to our virtual fracture clinic with a suspected or confirmed 5th metatarsal fracture. Plain AP radiographs were reviewed by two observers, who were initially trained on the 5th metatarsal classification identification. Zones were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. Patients were excluded from analysis if neither observer could identify a fracture or if one or more observers could not access the images. An inter-observer reliability analysis using Cohen's Kappa coefficient was carried out, and degree of observer agreement described using Landis & Koch's description. All data was analysed using IBM SPSS v.27.

Results:

1360 patients who met the inclusion criteria were identified. The two observers had moderate agreement when identifying fractures in all zones, apart from zone 1.2 and DM fractures, which only achieved 'fair' agreement (K=.308 and .381 respectively). Zones 1.1 (K=.538), 1.3 (K=.511), 2 (K=.515), 3 (K=.57), DS (K=.545) and Head (K=.558) all tended towards but did not achieve substantial agreement. Slight agreement with the next proximal and distal adjacent zones were found in Zones 1.1, 1.2 and 1.3. Slight agreement with the adjacent distal zone was found in Zone 2 and DM fractures. Zone 3 has slight agreement with Zone 2 proximally and there is an apparent difficulty with distal DS fractures resulting in a lot of crossover with DM, achieving a fair level of agreement (DS 312 vs 196; DM 120 vs 237; K=.398, p<.001).

Conclusion:

Reliability of sub-categorising 5th metatarsal fractures using standardised instructions conveys moderate agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow up during a virtual clinic review, defining fractures of zones 1-3 needs careful consideration.
Outcomes of Hemiepiphysiodesis in Treatment of Juvenile Hallux Valgus (Systematic Review)
Authors: Chaudry Faran , Ahmad Ihtisham , Gaber Karim E. , Shehab Mohammed , Wariach Sajid , Kishta Waleed
Published: November 2022

Category:

Bunion

Introduction/Purpose:

The aim of this study was to evaluate the efficacy of percutaneous hemiepiphysiodesis for JHV by investigating the available literature on the procedure.

Methods:

The literature search was conducted by using the following bibliographic electronic databases: EMBASE, MEDLINE, and PubMed.gov. Study screening at all stages was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. The Methodological Index for Non-Randomized Studies (MINORS) scale was used to evaluate the quality of included studies. Data on patient characteristics, radiological and clinical outcomes, and notable complications were also collected.

Results:

Of the 91 studies identified by our search strategy, 4 met the inclusion criteria. The identified studies included 62 patients and 109 feet. The mean hallux valgus angle (HVA) improved preoperative to postoperative at a range of Δ3.45 to Δ5.5. The mean intermetastartal angle (IMA) improved preoperative to postoperative at a range of Δ2.2 to Δ4.0. The mean HVA progression per month improved from preoperative to postoperative at a range of Δ0.07 degrees/month to Δ0.17 degrees/month. The mean IMA progression per month improved from preoperative to postoperative at a range of Δ0.046 degrees/month to Δ0.067 degrees/month. Of the studies that reported a mean American Orthopaedic Foot and Ankle Society (AOFAS) score or a mean Hallux Metatarsophalangeal Interphalangeal Scale (HMIS), there was an improvement at a range of Δ16.5 to Δ36.

Conclusion:

Percutaneous Hemiepiphysiodesis can serve as an effective procedure for treating Juvenile Hallux Valgus.
A Novel Technique of Minimally Invasive Calcaneal Osteotomy for Intractable Insertional Achilles Tendinopathy Associated with Haglund Deformity
Authors: Choi Jun Young , Suh Jin Soo
Published: November 2022

Category:

Hindfoot

Introduction/Purpose:

To date, minimally invasive surgery (MIS) involving calcaneal osteotomy for Haglund deformity associated with intractable insertional Achilles tendinopathy has not been reported. This study presents the radiographic and clinical outcomes of our novel MIS-dorsal closing wedge calcaneal osteotomy (DCWCO) technique compared to open Haglund resection. We hypothesized that earlier clinical improvement after MIS-DCWCO could be achieved by leaving the Achilles tendon insertion site untouched.

Methods:

We retrospectively reviewed and compared the clinical and radiographic parameters of patients who underwent MIS- DCWCO (11 cases) or open Haglund resection (14 cases) between January 2012 and June 2019. The minimum duration of follow-up for inclusion was 18 months. We measured the calcaneal pitch, Meary's, Fowler-Philip, and Böhler's angles. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores measured preoperatively and at 3, 6, 9, 12, and >=18 months, postoperatively.

Results:

In both groups, the Meary's and calcaneal pitch angles did not change significantly, whereas the Fowler-Philip and Böhler's angles were significantly changed postoperatively. Significant improvements in VAS and VISA-A scores were observed in both groups (P < .001). The extent of correction of the four radiographic and two clinical parameters were not significantly different between the two groups. However, VAS and VISA-A scores at postoperative 6 months were significantly different, whereas these parameters were not significantly different at all other time points.

Conclusion:

Both techniques provided similar postoperative clinical and radiographic improvement. However, MIS-DCWCO achieved earlier clinical improvement than open Haglund resection.
A Study of Treatments of Congenital Clubfoot in Cerebral Palsy: A Systematic Review
Authors: Chu Alice , Hanna Aedan , Hanna Adeeb J. , Veliky Jacob , Hoon Choi Jae , Nguyen Julia , McGrath Aleksandra , Kaushal Neil , Edobor-Osula Folorunsho , Shihora Dhvani
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Cerebral palsy (CP) can lead to various foot deformities, including equinovarus, or clubfoot position. Patients with CP present a challenge when treating clubfoot as there is aberrant muscle tone and motor dysfunction. Many interventions with variable outcomes are available for patients with clubfoot and cerebral palsy, however, no studies exist that compare existing treatments and outcome measures. The purpose of this study is to investigate the existing body of evidence surrounding the treatments and outcomes of clubfoot in cerebral palsy by way of a systematic review.

Methods:

Using PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Publications were collected which represent all available literature on clubfoot. Articles were screened at the title, abstract, and then full-text level. Only articles that detailed the treatment of pediatric patients with clubfoot, CP, and contained three or more human subjects were included. Publications were excluded from further screening if they were found to be duplicate articles, historical reviews, professional opinions, case reports, or if subjects were non-human. At each level of screening, articles were screened by two independent reviewers to verify that each paper met the predetermined inclusion criteria. Following this, data extraction from primary sources was conducted for; number of patients, age of patients, follow-up length, treatment modality applied, and outcome measures. T-tests were performed using SAS statistical software to determine the relationship between age and type of intervention.

Results:

An initial search yielded 6,469 articles, after review and cross selection, 32 remained as shown in Table 1. Of these, 53.13% (n=17) articles documented surgical tibial tendon transfer (TT): anterior TT (n=5) (mean-age 10.12 +-3.40yrs), posterior TT (n=12) (mean-age 9.30 +-2.57yrs). Botox & casting was referenced in 15.63% (n=5) articles (mean age 5.34 +-1.21yrs), lengthening of tendon or muscle procedures 12.50% (n=4) (mean age 6.30 +-1.69yrs), botox alone 12.50% (n=4) (mean age 6.83 +-1.72yrs), and osteotomy 6.25% (n=2) (mean age 10.94 +-1.51yrs). There was a difference in age for patients receiving TT versus those receiving botox & casting (9.54+-2.75 years old vs 5.34 +-1.21yrs years, p<.05).

Conclusion:

These results indicate the preferred modality of clubfoot correction in the setting of cerebral palsy is tibial transfer. The average age of patients receiving surgical treatments was higher than those with casting, Botox, or orthotics. Due to a lack of standardized outcome measurements reported across studies, we recommend further research aimed specifically at evaluating intervention selection based on patient desired functional outcomes.
Functional Outcomes of Primary Arthrodesis vs Open Reduction and Internal Fixation in the Treatment of Lisfranc Injuries
Authors: Gal Zsombor T. , Pectol Richard W. , Kalbac Tyler , Dawson Ashley N. , Sneed Chandler , Albano Ashley Y. , Kavolus Matthew W. , Aneja Arun , Srinath Arjun K.
Published: November 2022

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

The lack of data regarding functional outcomes of midfoot primary arthrodesis (PA) and open reduction and internal fixation (ORIF) contributes to significant debate regarding the optimal method of treatment for Lisfranc injuries. Although PA is associated with lower rates of secondary procedure and posttraumatic arthritis, its impact on foot functionality has come into question due to sacrifice of tarsometatarsal (TMT) mobility. The authors hypothesize that there is no significant difference between patient recorded outcome measures (PROMs) among patients receiving PA and ORIF for the treatment of Lisfranc injuries.

Methods:

A retrospective cohort study of patients surgically treated for Lisfranc injuries between January 2010 and January 2019 at a Level I trauma center was undertaken. Retrospective chart review was utilized to obtain patient demographics, comorbidities, procedural information, complications, and additional treatments. Responding by survey, patients reported their functional competency in performing daily and sports-related activities via the validated Foot and Ankle Ability Measure (FAAM) instrument. For each patient, scores for the Activities of Daily Living (ADL) and Sports sections were calculated. Patients also reported their perceived current level of function on a percent scale with respect to functionality prior to TMT injury.

Results:

Twenty-four patients underwent PA, and 27 patients underwent ORIF. There were no significant differences between age (P=0.55), incidence of high energy injury mechanisms (P=0.14), comorbidities, or time to surgical intervention from injury (P=0.25) among PA and ORIF groups. There were no significant differences in FAAM scores among PA and ORIF groups. The average ADL scores for PA (72.42 +- 17.53) and ORIF (68.11 +- 28.24) were not significantly different (P=0.52), nor were the average Sports scores for PA (47.92 +- 25.48) and ORIF (48.56 +- 29.44) groups (P=0.94). However, patients in the PA group reported a significantly higher level of perceived ADL function (77.96% +- 17.97%) compared to patients in the ORIF group (60.04% +- 35.47%, P=0.03); this was not the case for perceived Sports functionality (P=0.67).

Conclusion:

This analysis of PROMs revealed no significant difference in the ability to participate in ADLs and sports between PA and ORIF groups. These results align with our hypothesis and suggest that despite sacrificing TMT joint mobility, functional outcomes of patients receiving PA were not significantly different from those receiving ORIF for Lisfranc injuries.
Septic Tenosynovitis of the Lower Extremity: A Case Report
Authors: Garber Hollie , Michel Chris , Abdelmalek George , Sudah Suleiman , Kerrigan Daniel J. , Dijanic Christopher M. , Ali Sayed
Published: November 2022

Category:

Other

Introduction/Purpose:

Tibialis anterior rupture is an exceptionally rare complication of septic tenosynovitis. One case of septic tenosynovitis of TA has been previously documented by Lowell et al. 2020 It is worth noting in this case, that TA was unruptured. In this abstract, we present a case of TA rupture secondary to septic tenosynovitis.

Methods:

A 46-year-old female with a past medical history of depression, HIV, HCV, Diabetes Mellitus, medication noncompliance and current heroin abuse presented with 2 days of right ankle pain. She also reported fever, chills, diaphoresis, nausea and vomiting. She was diagnosed with right foot cellulitis based on clinical findings of erythema, induration and tenderness. She underwent computed tomography (CT) with contrast of her right lower extremity which showed a peripherally enhancing fluid collection surrounding the tibialis anterior tendon consistent with tenosynovitis. There appeared to be medial extension beyond the tendon sheath (Figure 1). A sagittal view is provided in Figure 2, which further demonstrates the fluid collection.

Results:

She had an I&D of the fluid collection and started on IV vancomycin. After admission to the medical floor, blood cultures were drawn. The patient failed to improve after 2 days of vancomycin therapy. The blood cultures were negative. She subsequently had MRI of her right lower extremity that showed a persistent peripherally enhancing fluid collection anterior to the tibialis anterior tendon and high-grade partial tear of the tibialis anterior tendon (Figure 3). She was then taken to the operating room for a repeat incision and drainage where the tendon sheath of the tibialis anterior was incised and the tendon was exposed with washout. Wound cultures were drawn, and afterward, her antibiotic regimen was broadened with Piperacillin-Tazobactam. She was taken back to the operating room a third time for primary closure of the wound. Wound cultures grew methicillin- sensitive Staphylococcus Aureus resistant to clindamycin and she was discharged on Bactrim.

Conclusion:

Septic or suppurative tenosynovitis is the infection and inflammation of the closed synovial sheath of a tendon. These infections typically involve the tendons and tendon sheaths of the flexor muscles in the hand. The potential spaces of tendon sheaths create a walled-off environment ideal for pathogens to grow in isolation from host defenses. he pathogenesis of septic tenosynovitis typically involves trauma from a laceration, puncture or bite but other cases of disseminated hematogenous spread have been reported (Newman et al., 1989). Both medical and surgical management is recommended for the best possible outcome.
Computed Tomography Scan vs Saline Load Test in the Detection of Traumatic Arthrotomies of the Ankle: A Cadaveric Study
Authors: Gheewala Rohan A. , Lakra Akshay , Mori Benjamin Villacres , Carroll Jeremy D. , Mulligan Michael
Published: November 2022

Category:

Trauma

Introduction/Purpose:

The diagnosis of traumatic arthrotomy is typically made through a saline load test (SLT), though there has been a growing base of literature regarding the use of computed tomography (CT) scan in various joints for diagnosis. To date, there has been little data supporting the use of CT to diagnose traumatic arthrotomy of the ankle. Through simulated arthrotomies of the ankle in cadavers, we aim to assess the sensitivity and ability of CT for diagnosing traumatic arthrotomy. SLT were also performed in each specimen to determine the volume of saline needed for diagnosis.

Methods:

Six fresh-frozen cadavers with twelve ankles were initially included in this study. The presence of intra-articular air prior to arthrotomy was excluded with a baseline CT scan. Ankles underwent arthrotomy at the anterolateral, anteromedial, posteromedial, posterolateral portals with fluoroscopic guidance. A subsequent CT scan was obtained to identify the presence of intra-articular air. Ankles then underwent SLT and volumes resulting in extravasation were recorded.

Results:

Eleven ankles were included, with one exclusion due to the presence of implants. Arthrotomies were made in three ankles at the anterolateral portal, three at the anteromedial portal, two at the posteromedial portal, and three at the posterolateral portal. Following arthrotomy, intra-articular air was detected in all eleven ankles by CT scan. All eleven ankles were subjected to SLT, with each demonstrating extravasation through the arthrotomy site. The mean volume of saline needed for extravasation was 7.7 mL, with a range of 3 to 22 mL and a standard deviation of 5.4.

Conclusion:

CT scan was demonstrated to be sensitive and effective in diagnosing traumatic arthrotomy in a cadaveric model.
Does Sesamoid Pathology Adversely Impact Outcomes of Cheilectomy in the Treatment of Hallux Rigidus?
Authors: Gheewala Rohan A. , Bono Olivia J. , Rosenbaum Andrew J.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus (HR) is the most common degenerative pathology of the foot, marked by degenerative osteoarthritis of the first metatarsophalangeal joint (MTPJ) and reduced sagittal motion. Cheilectomy remains the standard of treatment, with satisfactory pain relief and increases in MTPJ range of motion (ROM). While the majority of these patients have satisfactory outcomes, a subset remains dissatisfied with persistent pain and poor ROM. In this study, we aim to assess the effect of sesamoid pathology on the functional outcomes of those undergoing cheilectomy for hallux rigidus.

Methods:

Electronic medical records were retrospectively reviewed to identify patients who underwent cheilectomy, with or without a corrective osteotomy (Moberg or Akin) for a diagnosis of HR, identified through CPT code 28289. The data referenced was from November 2019 through November 2021, belonging to three fellowship-trained foot and ankle specialists at a single high volume orthopedic practice. Exclusion criteria included revision procedures, loss of follow-up prior to one year, and prior sesamoidectomy. Our assessment included the presence of sesamoid arthritis or degeneration, demographic data, stage of HR according to the Coughlin and Shurnas classification on preoperative plain radiographs, a patient-reported pain scale, postoperative satisfaction, ROM, and return to activity. Patients were followed at 6 weeks, 3 months, 6 months, and 1 year. Complications were recorded. Statistical analysis was performed using Pearson's chi-square analysis and a two-sample t-test with significance set at alpha <0.05.

Results:

In this retrospective study, 74 patients who underwent cheilectomy for the treatment of hallux rigidus were examined; 1 with grade 0 HR, 7 with grade 1 HR, 51 with grade 2 HR, and 15 with grade 3 HR. There were 33 with radiographic evidence of sesamoid arthritis, 41 without. Those with sesamoid arthritis trended towards having less pain relief over the course of our study (p=0.290) and more restricted postoperative ROM (p=0.385), though neither reached significance. There was no difference in complication rates between the two groups (p=0.661).

Conclusion:

The presence of sesamoid pathology appears to trend towards worse outcomes after cheilectomy for the treatment of hallux rigidus. Patients with sesamoid pathology may go unrecognized and may warrant consideration for modalities of treatment beyond cheilectomy for hallux rigidus for more satisfactory outcomes. This study is limited in its power and would benefit from greater sample sizes and more objective parameters of measurement. Nonetheless, this data allows for recognition of these patients in whom cheilectomy does not result in pain relief with the goal of identifying factors to improve care and provide sufficient treatment.
A Prospective Evaluation of a 4th Generation Total Ankle Prosthesis with 2-Year Follow-Up
Authors: Gross Christopher E. , Strasser Nicholas L. , Vora Anand M. , Friscia David A. , Doty Jesse F.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The availability of fourth-generation ankle replacements has burgeoned over the past several years. These ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. Documentation of implant survivability and comparison studies of the latest generation implants are limited. The purpose of this study is report on prospectively collected patient reported outcome measures (PROMs) in a multi-institutional study of a fourth-generation total ankle.

Methods:

Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in both academic and private settings. Each patient received an INFINITY ankle prothesis (Stryker, Memphis, TN, USA) Patients had demographics and PROMs recorded pre-operatively and at 6 month, 12 months, and 24- month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, Foot and Ankle Outcome Score (FAOS), and satisfaction scores. The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed.

Results:

A total of 147 patients were enrolled :(54.7% male) average age of 64.2 +- 9.4 years old, average BMI of 31.0 +- 5.2. pre- operative diagnosis for arthritis type was degenerative arthritis (48.7%), rheumatoid arthritis (2.7), post-traumatic arthritis (47.9%), and other (0.70%). Thirty-seven percent of patients had previously undergone surgery at the index joint. Eighty-eight patients had at least two years of follow-up. There were 3 (1.3%) clinical failures:(2 with aseptic tibial component loosening: at months 17 and 21, and 1 tibial subsidence at month 14). The patients improved in all PROMs domains at two years including: Mean Total AOS (17.2 +- 18.3, p<.0001); PROMIS Global Physical Health (47.6 +- 7.4, p<.0001); Total FAOS (76.3 +- 18.7, p<.0001). 97.5% of patients were satisfied with their surgery.

Conclusion:

At two-year post-implantation follow-up, the INFINITY total ankle replacement had a low revision rate and proved to be safe and effective compared to historical ankle replacement outcomes. Patients were overwhelmingly satisfied and had statistically significant clinical improvements in each domain of their PROMs.
Do COFAS Scores Effect the Outcomes of a 4th Generation Total Ankle Prosthesis? A 2-Year Follow- Up
Authors: Gross Christopher E. , Strasser Nicholas L. , Friscia David A. , Vora Anand M. , Doty Jesse F.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. In order to better compare and stratify pre-operative ankle arthritis patients, the Canadian Orthopaedic Foot and Ankle (COFAS) pre-operative classification for end-stage ankle arthritis score was developed. The purpose of this study is report on how the COFAS scores effects prospectively collected patient reported outcome measures(PROMs) in a multi-institutional study of a fourth-generation total ankle replacement.

Methods:

Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in both academic and private settings. Each patient received an INFINITY ankle prosthesis (Stryker, Memphis, TN, USA). Patients had their COFAS pre-operative classification for end-stage ankle arthritis scores, and PROMs recorded pre-operatively and at 6 months,12 months, and 24-month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed.

Results:

A total of 147 patients were prospectively enrolled. for study participation. COFAS types; were delineated as Type 1 (42.6%, isolated ankle arthritis), Type 2 (27.0%, ankle arthritis with varus or valgus deformity, tight Achilles, ankle instability), Type 3(4.7%, ankle arthritis with hindfoot deformity, tibial malunion), and Type 4 (25.8%, Types 1-3, plus hindfoot arthritis). Eighty-eight (88) patients had at least 24 months of follow-up. COFAS Types 1, 2, 3, and 4 patients had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p<0001). The type and severity of deformity or amount of hindfoot arthritis, hindfoot deformity, or ankle instability significantly effected the PROMs in those patients with at least 2-year follow-up. Implant revision rates were not affected by COFAS type, and there were three revisions (One Type 4 and two Type 2).

Conclusion:

At two-year follow-up, all study participants had significant improvements in PROMs, regardless of COFAS Type. These results suggest that COFAS type has little impact on patient outcomes using current generation total ankle replacements. Longer term follow-up may serve to further confirm these promising early results.
Effect of Insertion Trajectory on the Compressive Performance of Intramedullary Devices for Subtalar Arthrodesis
Authors: Gross Christopher E. , Beals Caitlyn , Dupont Kenneth , Safranski David L.
Published: November 2022

Category:

Hindfoot; Other

Introduction/Purpose:

Subtalar arthrodesis is a common procedure to treat hindfoot pathologies. Prior studies have evaluated the effect of screw trajectory on the initial compression of the subtalar joint. More recently, intramedullary (IM) devices using pseudoelastic NiTiNOL, developed for subtalar arthrodesis, can apply sustained dynamic compression (SDC). Headed screws' compression is achieved via the lag effect and is dependent upon its fixation in bone. The SDC device's compression is achieved by a manual mechanism; however, its fixation is dependent upon transverse screws. However, it is unknown how the trajectory of these devices in the subtalar joint alters compression. The aim of this study is to determine how the trajectory of both static compression screws and sustained dynamic compression devices affects joint compression.

Methods:

Based upon previously published methods, a synthetic talus and calcaneus were mechanically isolated in a custom fixture, and the compression measured via a load cell located in parallel to the subtalar construct. Static headed screws were inserted either in a parallel configuration across the posterior facet or in a diverging configuration across the posterior and anterior facets. A single IM SDC device was inserted across the posterior facet or the anterior facet and secured in the talus and calcaneus via transverse cortical screws. The resulting compression was measured in a thermal chamber at 37°C (n=8/group). Devices were inserted following the manufacturer's recommended instructions. Data was tested for normality using the Kolmogorov-Smirnov test. A one-way ANOVA was performed with a post-hoc Tukey test (α=0.05). All values are given as mean +- standard deviation.

Results:

The SDC device's compression was 398+-47N in the posterior facet and 417+-31N in the anterior facet (p=0.64). The screws' compression was 267+-31N in the parallel configuration and 269+-21N in the diverging configuration (p=0.99). The single SDC device, regardless of position, had significantly greater compression than the parallel or diverging headed screws configuration (p<0.01).

Conclusion:

The SDC device's compression is not affected by insertion trajectory, thus allowing for surgeon preference in anatomic placement. The SDC device is able to generate more compression than the headed screws, regardless of trajectory or screw configuration.